Thursday, 6 March 2025

Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Bill 2025

Second reading

Debate resumed on motion of Mary-Anne Thomas:

That this bill be now read a second time.

Roma BRITNELL (South-West Coast) (10:16): I rise to speak on the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Bill 2025, but can I just take leave for a minute to wish everyone, particularly the women of the state of Victoria and South-West Coast, a happy International Women’s Day and shout out to all of the women, particularly in South-West Coast, who contribute to our community, to our businesses and to our families for all the wonderful work that women do. I am honoured today to host Annette Hart and Alison Shawyer, two women who served as ambulance officers, in our Parliament today. We honour the good work that emergency services and particularly the women in emergency services do. Happy International Women’s Day.

I would also like to start the debate today by commenting on the wonderful work that our healthcare workers do. Having been a nurse for 30 years in the system, I know all too well how committed our nursing staff, our allied health staff and our medical staff are and just how hard they are working, particularly at the moment. There is no doubt that we have in Victoria a health crisis, and that means and I see that these wonderfully committed, hardworking, caring people are working harder than they ever have before. Not for one minute would I ever say anything to the contrary of that, having been at the coalface myself and knowing just how difficult it is to hold the hand of a dying patient knowing that you have got other patients requiring your attention at the same time or to get a patient quickly up to the theatre to have a quick operation or an X-ray when someone is in pain and about to faint on you. I know exactly how hard that is, so I would like to pay credit to all those people who dedicate their lives to the health system.

I stood here nearly 10 years ago in this role – and I always like to see credit given where credit is due ‍– and I remember saying with the first bill I ever spoke on, which was the medicinal cannabis bill, that we are very privileged in Victoria to have a wonderful health system. Sadly, 10 years on I genuinely cannot say that. I genuinely do not feel that the system is working. Once again, the people within the system are doing an extraordinary job in extraordinary circumstances. But to prove my point, never have I seen before doctors speaking out like they are at the moment. I had a rally in Portland a few years ago due to the cuts and the services that were being diminished in that hospital and the services that they were struggling to deliver. Doctors were speaking out and attending rallies. We saw last year Mansfield had doctors, nurses and health staff rallying the streets, pushing against the government’s cuts and amalgamations and merger discussions. Right around South-West Coast we have had meetings where all the health system people were coming in and saying that this is not to be tolerated. Just yesterday in the Parliament we saw the people of Wodonga and, again, doctors speaking out loudly because they are so desperate to look after their patients and speak up about how the crisis that they are working within is really happening.

The challenge we have is health is a really complex system, and it is very overwhelming for patients. When you are diagnosed with something significant – I know from experience – even with a health background, you really do struggle to absorb everything and it is really complex. The excuses given for why you cannot have a certain treatment or why you cannot have a certain test can often not be the right reasons – you are not going to tell your patients it is because of cuts and because you do not have enough money – but we are seeing that.

For a bit of background, and the reason I am talking about the crisis, is that this is a bill that the government announced in 2015. It was the Andrews Labor government that introduced the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Bill 2015. There have been a couple of amendments since then – in 2019 and 2020 – and now, again, in 2025. This is a bill to enshrine in law the minimum staffing levels for nurses and midwives in the Victorian public health system. These ratios were previously part of the nurses and midwives enterprise agreement.

What this is supposed to achieve is better patient outcomes and better health outcomes by making sure there is the right amount of nurses to patients in certain circumstances. Previous amendments over the last five years have included increased ratios in specific settings – such as the stroke, haematology and oncology wards – and in palliative care, aged care, birthing suites and emergency departments. This bill is the third phase, which was promised by the government as an election commitment in 2022. It introduces higher minimum staffing levels in intensive care units, high-dependency units, coronary care units and emergency departments.

The bill seeks to improve patient care and patient safety within legislative requirements with more nurses and midwives across the public health system. It makes changes to level 1 and level 2 hospitals. In ICUs a one-to-one nurse–patient ratio will be required for occupied ICU beds. That is actually something we had 30 years ago. We always had one nurse to one ICU patient. You never had an intubated patient without a nurse beside the bed 24 hours a day. Some of these things have been done by nurses and health staff for a long time. It is formalising a longstanding, accepted rostering practice, and that is a good thing.

For level 1 and level 2 ICUs new requirements are introduced for a team leader, a liaison nurse and a charge nurse of a unit; a one-to-one nurse–patient ratio for a resuscitation cubicle in an emergency department – again, I do not think I have ever seen anyone be on their own in a resuscitation cubicle – so the morning shift will be in line with the afternoon and night shifts; a one-to-four nurse–patient ratio for night shift on postnatal and antenatal wards – currently it is one to six; level 4 services as part of a larger metropolitan service for level 5 and level 6 services under the maternity capability framework; and an in-charge nurse on night shifts in standalone high-dependency units and primary care units. The bill also updates the lists of hospitals in the schedules of the act to reflect changes to the names of some services. The new ratios will be phased in over three stages to give health services time to implement staff changes. Hospitals must have the 25 per cent additional staff requirements in place from the day after royal assent, 75 per cent from 1 December 2025 and 100 per cent from 1 July 2026.

We do not oppose this bill. I understand the importance of having the right amount of staff for patients. I am very, very clear that that is an important role for hospitals to carry out. But I do have concerns about how hospitals will meet these ratios and how they will actually deliver on the ground. The funding the government gave to implement the increased staffing levels was $101.3 million. However, we have not had the detail of this allocation provided in the budget papers. That leaves an area of concern for me; I cannot understand how it will actually be implemented.

Let us remember that when the government was really pushed last year with the health communities coming out very vocally and saying, ‘You’re just pushing us too hard,’ the government backflipped and put a sweetener in the mix of $1.5 billion. But look at just one example. It might sound grand to say $1.5 billion, but the increased WorkCover costs that hospitals have to find and meet for the year ahead of them is $85 million. We are seeing hospitals having to find 100 per cent extra on what they found the previous year for the WorkCover costs that have increased. We know that health services are already under enormous financial strain.

We have seen many articles coming out in the paper where several major hospitals are operating in deficit and are struggling to pay staff and bills on time, and these are very concerning articles. They are very concerning facts – that the hospitals cannot pay their bills.

It is unclear if the allocated funding will be sufficient to meet the higher costs of employing more casual agency nurses. If a hospital is unable to recruit the permanent staff, what are they supposed to do? Use agency. What does agency do? It increases the budget. They only get a global budget. They do not get a specific amount allocated for this – well, they do, but my point is, will it be enough, because we cannot get the detail? Given the financial pressures throughout Victoria’s health system, the new nursing ratios could lead to further budget constraints elsewhere, such as planned surgery. Will they have to cut surgeries? Will they have to shut beds? If you cannot meet the legislative requirement of the ratios and there just is not the workforce available, what is the hospital supposed to do? And remember what I said earlier, these are very committed health people. The managers, the CEOs and the boards take their role incredibly seriously and very personally, and they feel very much that they are letting their communities down if they cannot meet the requirements. So it is a very challenging space for these people to be in, having these requirements and not having the backing from a government that says, ‘This is how we’ll implement it.’

In the bill briefing, when asked if modelling was actually done regarding the impact of the broader health workforce, especially given that existing nurse shortages exist, the Department of Health representatives said it will be left to the health services to review their operational capacity. In other words, the homework has not been done. It is a wonderful announcement; it is fantastic. Every nurse would say, ‘Good. I want to make sure I can give my patient the best care I can possibly give them and not feel like I’ve got five other patients that are desperately needing me right now when I can’t meet their needs.’ But if it means we are going to steal from somewhere else and leave some other nurse or patient in a compromised position, are we really actually addressing the problem or is it an announcement without the homework and resources behind it that will actually deliver better patient outcomes and better patient care?

I thank the minister for the briefing to give us the information to understand how this bill will work, but when we asked the department in the briefing which hospitals have not been able to meet existing ratios, it was actually taken on notice. At the time of me preparing for this bill, we had not received a response. So that tells us they do not know how the previous amendment was delivered. Have we actually achieved this, or are hospitals not able to achieve it because there just is not the workforce available? When asked also about the extent of the additional workforce required – so the question was how many more nurses this will need – the department was unable to provide a figure. I mean, if that does not tell you that this was an announcement – ‘We’re going to do some great things,’ the Labor government said at election time, ‘We’re going to put more nurses on so you’ll get better patient outcomes and better health outcomes.’ They have not done the work to say where they are getting the additional workforce from or how many they will need. How can we believe that this will work effectively and not just put more pressure on nurses and more pressure on the wonderful management and staff that are doing their damnedest to make their hospitals the best they can be? In short, there was no modelling done.

Another aspect of the bill shows that nurses in ICU can care for up to two patients if they are not critically ill – so probably two cardiac patients versus two intubated patients – but in the bill, we could not get a definition of what that means. I mean, I am saying ‘probably’ from experience, but I do not know. Things have changed, and there will be so much more pressure. What does ‘critically ill’ or ‘not critically ill’ mean?

In short, this is really rushed legislation. That election was over two years ago, and so when I say it is rushed, they have had two years. The Allan Labor government have had two years and are trying to deliver a promise made before an election, but they have not put any grunt behind the work to figure out how this will be delivered. Unfortunately, no modelling has been done on how it will affect hospitals. How will we know if we need more nurses in ICU, and where are they coming from? There is no modelling. What if the hospital cannot recruit or find more nurses? What if Portland hospital cannot attract more nurses? What if there are just not nurses in Victoria? And that is what we have been finding – nurses are so burnt out, they are working so hard and they take it personally. I know this for a fact. I speak to them daily.

Will they simply have to redeploy nurses from another area of the hospital, perhaps from the surgical theatres or other wards? Will it just become robbing Peter to pay Paul? And what happens to those surgical wards or theatres now? Do they close? Do we see beds closed? Do we see that these arbitrary ratios maybe just cannot be met?

This is a smoke-and-mirrors announcement. The government have not done their homework. Whilst trying to improve patient ratios in intensive care, high-dependency units, coronary care units and emergency departments is all very noble, the problem is: what will it do to other areas? It is very prescriptive, enshrining in legislation ratios that will provide less flexibility for hospital management to manage their staffing in its entirety and understand what is going on at the coalface in their areas and their regions. I think it might lead to hospitals losing services, and that will give the government justification to be able to implement the cuts they have been trying to implement anyway. As I said, health being so complex, I am pretty sure that they will probably pull the wool over many people's eyes and the patient outcomes will not be better.

I just want to give a bit of a reality check here, because I am hearing, as the rest of the state is, that this is COVID’s fault: ‘We’ve got a health crisis because we had an infectious disease called COVID.’ Can I just say that the COVID-specific debt is $40 billion. Victoria’s debt is $188 billion. The reality is the Allan Labor government have a track record of ‘borrow and binge’ – borrow money, binge on large infrastructure projects that have cut essential health services. Labor are picking on health so they can do these big, big builds in the city and not actually deliver to the health sector or do the basics of governing a state. It is wrong, and I am absolutely devastated by what I see.

I had my father die last year in the health system. I walked that journey with him for three months, and I cannot compliment the staff more. They were amazing, wonderful, committed people. But as a nurse who knows the system well, I saw over and over again that system was broken, and so many times he fell through those cracks. If both of his daughters were not nurses, I am horrified at what would have happened, because the system is broken, not the wonderful staff.

These recent announcements by the government to amalgamate our health services are nothing short of a government realising they are out of money. Luckily, in South-West Coast, we did not get swallowed up by Geelong. That is a great outcome, and I compliment the managers. We have some fantastic managers. We have got a new CEO appointed to Portland hospital, Karena Prevett, and I wish her well in that role. I hope she is well supported by the government, because Portland hospital is an incredibly important hospital that serves a busy port and busy industrial businesses. We need urgent care, and we need to be able to have babies in Portland, because it is a long way from Portland to Melbourne or Adelaide. And we have got wonderful staff and managers at Heywood, Port Fairy, Terang and Warrnambool. They are absolutely working together and doing such a great job of building the health service. But let us remember they are having to do what the government tells them to do. They are actually getting directives from the minister to find ways of cutting the businesses so that they can bring back savings to meet the government’s debt – a debt created by mismanagement, not by COVID.

Over the last few years medical staff keep speaking to me about what is really going on, because when the government wanted to see these health cuts – and we saw the amalgamation discussions – they bullied the CEOs into silence, and we all knew that; we all read about it, we all saw it. Many of us had our CEOs and boards telling us they were too scared to speak because they were told they would lose their jobs, but my experience is they are still doing this. When I raise issues here in the Parliament, naturally not identifying who people are – like our theatres not being used to full capacity – the Minister for Health works with the Department of Health and the intimidation comes down the line to try and silence health workers.

As I said, I worked for 30 years in the public system. I know the system, and I will not shut up. I will not be silenced. I will speak up for my community. I do not want to see people worrying about their health and thinking it is hysteria, but I am also not going to let them believe that it is good when they need to speak up as a community. The government are so nervous about this dissent, and they want to quash criticism. They do not want to either be accountable or transparent. It is our health system, it is our taxes, it is our future and it is our children’s health and our parents’ health, but the government want to keep a facade, the smoke and mirrors, even if it involves intimidating staff at the coalface, which I have actually been told my friends are experiencing. I am absolutely shocked by it, but if that is how the government want to behave, they will not silence me.

We see examples of wonderful announcements like this one with no homework behind them. The solar announcements – hospitals were all told they had to put solar panels on the roof. Did they actually get any extra money for that? No. So where does that money come from? Cuts to services. We have got a waitlist for elective surgery at 62,800. Sorry, COVID started five years ago. If there is a crisis in a family, parents work out how they are going to work out a solution going forward. You do not just keep making excuses, you deal with the problem.

I sat on a perinatal inquiry in 2016, with others beside me and from across the chamber – the member for Frankston was the chair of that committee – and we made recommendations, bipartisan recommendations, that we needed to recognise that in five years time, if the Labor government did not incentivise, plan, attract and encourage a full complement of medical staff and allied health services, then we would find ourselves without enough people to deliver the services, and that is exactly where we are now. We have got birthing services being cut, we have got ophthalmology being cut and we have got people not being able to see a urologist in the south-west area. On these cuts the government says, ‘Oh, it’s because we haven’t got enough staff. It’s not our fault.’ Well, I am sorry, the role of a government is to plan and is to make sure they foresee, and that is why the inquiry occurred and that is why the recommendations were made. Not one recommendation has been delivered upon, and that is why we do not have a full complement to be able to operate surgeries, that is why we are short of anaesthetists, that is why general surgeons are not able to be found and that is why there is no urologist in South-West Coast.

That is why when I asked about a neurological-psych assessment that I needed to get done for my mother I was told that we do not have that service anymore in South-West Coast. Guess what, we have got to go to Geelong. Hang on a minute, isn’t what we were told when we were not getting swallowed up by Geelong, that we would not lose services? Well, I am watching very carefully, because we are losing services. We used to always be able to do neuro-psych assessments. Most people would not know what that is, and most people would go, ‘Oh, okay, that makes sense, I suppose. If we can’t do it here, we’ll go to Geelong.’ No, we always had the ability to do neuro-psych assessments in Warrnambool. There are private ones, so they are there. Why is the government not doing their job to attract, plan, encourage and incentivise these people to be servicing our communities?

Why is the Portland helipad still closed? Why isn’t the government saying, ‘Okay, we’ve changed some rules.’ Maybe there is some regulation. They will not tell us; we do not know. But if there is more security that needs to be in place because they are worried about someone driving through the yellow flashing lights or something and we need more security guards, put them on. Do not risk people’s lives by keeping a helipad that the community begged for, paid for and fundraised for shut. Do what needs to be done.

There are people like Bridget and Sandy Robinson, who are from Purnim, and their child Sidney, who has Hirschsprung disease. He has been supported at the Royal Children’s Hospital at the colorectal and pelvic reconstruction service unit. That is actually being cut, and this little boy who lives in Purnim will not have the support that his family needs to help him with his disease management. These cuts are real. The government keeps saying, ‘Oh, no, there’s nothing to see here.’

Very, very disturbingly, I had a conversation with a GP the other day, a GP with 40 years experience who I have known and worked with for many years. He told me that he cannot recommend a patient to go for a colonoscopy. One of his patients was rectal bleeding, a clear sign of cancer. We should always screen for these things, but he had to go through a process where the physician who was employed by the hospital had to tick certain boxes. Because the patient was bleeding, he was obviously going to administer treatment to stop the bleeding, because patient could die from that. Once the bleeding had stopped, they could no longer tick the box that there was rectum bleeding – it is a bit more complicated than that; I am trying to make it simpler for people – and that patient could not have a colonoscopy. If that patient in four years time is diagnosed with a stage 4 cancer, they will die. That is how that works. If that person has a colonoscopy now, they are more than likely going to live much, much longer – 20, 30 years. They will actually be able to cure that or prevent it from progressing.

I think, and this is my suspicion, that with 62,800 people on the waitlist, the government want to get it down, and one way to get it down is to not let people go on the waitlist. Because if you are waiting for a colonoscopy, you are a figure – you are a statistic on that list.

That was the most shocking story. I spoke to the doctor and said, ‘You’ve got to help me. You’ve got to speak up.’ And he said, ‘No.’ It is so complex that they will say, ‘Well, it doesn’t fit the criteria,’ and it does not. But a man with 40 years experience, a very capable doctor, is being ignored because there is a tick-box exercise and the flow chart goes one way.

I strongly suspect that we will also see in the next short while activity funding. This is a word that I am sure most people will not know, but the way we fund hospitals these days is we have activity funding. I reckon they are going to cut activity funding. Everyone will go, ‘Oh, that doesn’t mean anything. What does that mean?’ But what it means is to receive extra funding you have to fill out lots of forms and you have to provide what activity you are doing. Patients result in higher activity payments. This is a primary method of funding public hospitals. Hospitals are not given a fixed amount. It is based on the activity that they do. For an appendix, someone might go to hospital for a day, and they get so much activity funding; if they are in there for five days, they still only get a certain amount, and they lose money.

It is complex, but I think hospitals like Portland, Heywood and the smaller hospitals will see a cut to activity funding. The government should not be cutting services. Just because health is complex and difficult to understand, it should not mean that lower ratios in one area are requiring more staff and you have to increase funding in other areas. Low volume of activity should not mean we have to cut services. Just because a town, for example, has two babies delivered a week does not mean that local hospital does not need maternity services. It means there is just a lower level of activity and they need to still get that activity.

I look at things that the government are saying they are going to deliver – again promises that are not delivered. During the 2022 election they did not only announce the nurse–patient ratio, they also announced that a re-elected Andrews Labor government at the time, now Allan government, would give $44 million to deliver eight new PET scanners across the state, ensuring regional communities like Warrnambool would have access to life-saving diagnostic imaging – that is, a PET scanner. However, despite this commitment, the Warrnambool community still remain without their PET scanner. This is 2025, so this is forcing patients to go to Geelong, Ballarat or even Melbourne or Adelaide.

Warrnambool has two local providers, Lake Imaging, a private provider, and Lumus Imaging, also a private provider, who could actually deliver this. Lake Imaging have actually secured the necessary space, developed plans, engaged a fit-out company and sourced the required equipment and have the staff and community support in place. Lake Imaging can offer these services by bulk-billing, which I am pretty sure Lumus can as well, so there is no cost to the patient. So there is actually no difference between Lake Imaging providing the service and Lumus doing it. However, Lumus operate within South West Healthcare, and South West Healthcare are supposedly getting a $384 million hospital by 2027 – that is the ‘supposedly’ bit. We are certainly getting a new hospital, but we were supposed to get it in 2026. It is now meant to be 2027. There is no update other than the government saying, ‘Yes, of course, it will be on time.’ I strongly doubt that. When I look at the hospital right now, knowing how long things take to build, I cannot see it being built by 2027. I think that would be a reasonable thing to say. So here we are with, last year, Lakes Imaging saying. ‘We can have this ready in 16 weeks.’ That has well and truly passed, so patients are still waiting and going to Melbourne or going to other places when we could have this in place. Why should people have to wait? It makes no difference whether we have it at with one private company or another. The Epping hospital have just announced that they have had theirs for six months now.

The other issue that I think is worth raising is these cuts that the government are obviously facilitating. We are now seeing Deakin University in Warrnambool talking about cutting back the medical students program and making Warrnambool just a training hub. We have amazing doctor training in Warrnambool, which grew out of need. After the perinatal inquiry it was quite clear we needed to do something ourselves. So two very capable people, Associate Professor Barry Morphett, director of clinical studies at Warrnambool Rural Clinical School, and Dr Brendan Condon, deputy director of clinical studies – and I have known Barry since I started my training 40 years ago – who have given their heart and soul to our community, saw a need and saw the government were not going to do it, so they got in, advocated and set up a doctor training school.

Deakin have been spruiking that they understand the struggle that regions have and they want to actually provide an opportunity for locals to study medicine at home, and this medical school has an incredible reputation for fantastic doctors being produced. We have got 10 doctors – I was looking through the list – that have come through that school still in Warrnambool, so it is working. It has attracted other medicos. It assimilates the students into the community, and they stay. It is a roaring success. But last week Associate Professor Barry Morphett and Dr Brendan Condon began abruptly receiving notification they are no longer required. The town is in shock and the town is angry. When something has been working really well, why would Deakin come in and cut it? I strongly urge Deakin to reconsider. I suspect that this culture of cuts that the Labor government have got in place is giving opportunity to Deakin, and seeing that the announcement was made last week in Warnambool at the hospital, you would only imagine that the health department through the minister are part of this decision as well. I am pretty confident that Deakin will see a massive rebellion if they continue.

If the government was serious about health, we would not be seeing hospitals getting cuts. They have said they care about people. Well, let me tell you now: the only way to care about people is to actually fund the services properly and give the people on the ground the tools they need. This bill does not do that.

Paul EDBROOKE (Frankston) (10:46): I rise to speak on the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Bill 2025. I thank the member for South-West Coast for her contribution and her service as well. We work very well together on inquiries. However, I am going to have to take us down into a little bit of historical context.

It is great to hear that the opposition are supporting this bill today, it really is, but there was a time in 58th Parliament where I sat in the upper house and watched in the last session of that Parliament 20 Victorian Liberal opposition members and some independent members of that time filibustering that. Timing was very tight to get that bill through, and we heard opposition MPs drawing out speeches and filibustering in excess of 200 minutes to get to midnight so we had to pass the bill in and it would not pass. They were talking about the Melbourne Cup, they were talking about country race meetings, they were talking about bookies and they were talking about European cars – not the bill to employ an additional 611 nurses and midwives to improve patient care. I encourage those opposite who were not in Parliament at that time to read the Hansard of the day. You might find yourself asking some of your colleagues some very, very serious questions. It was a real stain on this Parliament, I believe. I am sorry people had to sit through that and sorry Australian Nursing and Midwifery Federation members had to sit through that as well.

Today I will just say to everyone in this house: do not bite the hand that heals you. Hold that hand, grab that hand and accompany our nurses through their journey of caring for us, because we would not be here without nurses. None of us would be here without nurses. In the past couple of years – without trying to offend anyone – I have seen too many nurses. From being blown up, from being in a plane accident and from a cancer scare – it was not a place wanted to be, but without nurses I would be absolutely six feet under. So let me reframe this argument. Let me reframe this debate appropriately for those of us who are not satisfied with that kind of iconoclastic argument those opposite are offering. I am so proud to be standing here today once again supporting our Victorian nurses, because they support us. They support every Victorian.

Everyone in this house, including those of us with new bubs that are actually visiting the house at times – which is so good; I love that – has seen a loved one who is sick, someone who we are unable to make feel better. It could be they are dehydrated, it could be they are in pain, or it could be a chronic illness or an acute illness. The feelings that we feel when we are incapable of actually helping our child or helping a loved one, the thoughts that go through our head about what do we do and where it is going to lead, evidently make us want to go and get help. The people that help us are the people we need, and they are our nurses.

The issue that we have heard a lot about is what has been happening in regional areas, which I think has very, very little to do with the bill. Those on this side of the house will be absolutely pleased that at the 2022 election it was a Labor government that decided to further protect and strengthen the ratios of our nurses and increase the safety of our community. We committed to that because it was what our nurses and midwives told us they wanted us to do. We have had a great relationship with our nurses and midwives, and our healthcare workers know that Labor, and only Labor, has their backs. I remember a very infamous time in history when a Liberal Party member gave the finger to nurses who were protesting back in 2012, and it still shocks me. That was around the time when we had people in the upper house doing that filibustering, so today to come in here with that wonderful change of heart that they will be supporting this bill is quite amazing. I just hope that opposition members who speak on this bill have actually read the bill and they know the historical context and their party’s history and they can touch on that. Maybe they can give us confidence that they really feel like they need to support our nurses.

In 2015 under a state Labor government Victoria became the first state in Australia to enshrine nurse-to-patient and midwife-to-patient ratios in law, and now the Allan Labor government is building on this by introducing stronger and safer nurse-to-patient ratios. The new ratios are the result of extensive consultation, and health services will be set in stone. The one-to-one nurse to occupied bed ratio in ICUs on all shifts for all level 1 and level 2 hospitals means that every occupied ICU bed has a dedicated nurse assigned to it at all times. ICUs will also require a team leader and a liaison nurse for the very first time. It includes improved staffing ratios in resuscitation cubicles in EDs on morning shifts, bringing morning shifts in line with afternoon and night shifts. It includes one-to-four midwife-to-patient ratios in postnatal and antenatal wards on night shifts, down from one to six. It includes an in-charge nurse on night shifts in standalone high-dependency units and coronary care wards as well.

To ensure that health services are adequately supported and prepared to action these changes, the amendments will be rolled out in a staged approach, with 25 per cent of the additional staffing implemented the day after royal assent, 75 per cent from 1 December 2025 – this year – and 100 per cent from 1 July 2026. These new ratios build on the Labor government’s 28.4 per cent pay increase for our hardworking nurses and midwives, helping to retain and recruit more nurses so more Victorians can get the very best care. As the son of two former nurses –

Belinda Wilson interjected.

Paul EDBROOKE: Yes, I am absolutely very proud of that – and with a daughter who is doing a nursing degree and has just changed to start studying paramedicine, it is a very, very proud heritage in our family of people who work in hospitals and work in health care to help people. It is something that I hold very close to my heart, and I am very proud of that fact in my family. That is why I have always been passionate that we should be ensuring that we pay nurses appropriately for what they do, because it is a tough job, especially with what our nursing and healthcare heroes went through during the global COVID pandemic. We asked a lot of them, and they delivered in spades – they really did. There was no whingeing and there was no stepping down; it was stepping up to meet the demand of our community.

Through this historic deal we are also recognising the historic undervaluing of this workforce, and I think that is an important step towards gender wage equity in Victoria. I think it is the first time we have seen that pragmatic approach happen and an actual result in that area, so that is very, very impressive. Again, those opposite possibly need to turn around and meet some nurses and have a chat about this highly feminised workforce and see some of those peculiarities that have not been acknowledged before that we are acknowledging now.

Since we have come to government we have grown our healthcare workforce by 50 per cent. We have grown healthcare staff by 40,000 nurses, midwives, doctors, allied health professionals and other hospital staff in the state’s health services. Almost one in four of these new roles has been created in rural and regional Victoria, and there are now 45 per cent more nurses and midwives and 78 per cent more doctors in our hospitals than when we came to office. In fact last year was the biggest yearly growth in Victoria’s history, with our workforce growing 6.7 per cent in one year. That is quite amazing.

Again, I would take those opposite who are going to speak on this bill back to 2018. You can stand here now and you can talk about how you are supporting a bill. Just have a look at the historical context, though, and maybe even stand up and apologise for what happened in 2018, when we saw a new government in the dawn of the 59th Parliament actually pass this legislation, because in the 58th Parliament, on the very last day, at dusk, we had people filibustering about racing and horses when they could have actually passed a bill which was the predecessor to this one, which would have employed 611 new nurses. To them I would say: do not bite the hand that heals you. Hold that hand, grab that hand and go on that journey with our nurses, go on that journey with our healthcare heroes, because you would not be here without them, I would not be here without them and you will need them some time. It might be tomorrow; it might be the next day. One of your family might need them. But you will need them, and you will be glad; you will be proud. Whatever creed your politics is, you will be proud that you stood here and you supported them when you are lying in a hospital bed getting help from them. With that I commend this bill to the house.

Brad ROWSWELL (Sandringham) (10:56): I also rise to contribute on the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Bill 2025. In doing so I acknowledge my colleague and friend, a member from the other place, Ms Crozier, for her contribution as Shadow Minister for Health in preparing the opposition’s response to this bill and the work that she has undertaken in order to assist her colleagues and mine with understanding the circumstance of the proposed law before the chamber this morning.

In 2015 the then Andrews government introduced the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Act 2015 to enshrine in law the minimum staffing levels for nurses and midwives in the Victorian public health system. These ratios were previously part of the nurses and midwives enterprise agreement. Since then there have been two phases of amendments to ratio requirements, in 2019 and 2020. This bill, as has been noted by an earlier government speaker, is the third phase, which was promised by the government as an election commitment in 2022. As the member for South-West Coast stated earlier, the Liberals and Nationals do not oppose this bill and its intent to improve safety and achieve better health outcomes for patients, as well as more support for nurses and midwives.

The government has allocated some $101.3 million to implement the increased staffing levels. However, in our view, it has not been able to provide the details of this allocation in the budget papers. I know that my colleagues who attended the government’s bill briefing specifically asked this question. It is one thing to make a legislative change to increase the ratio levels within the health system; it is another thing to be able to identify precisely where the cash is coming from and where it has been allocated. To this point, the government, although it has allocated $101.3 million, has not been able to provide the details of this allocation in the budget papers, which is of concern to us. It is unclear if the allocated funding will be sufficient to meet the higher costs of employing more casual agency nurses if hospitals are unable to recruit permanent staff. Given the financial pressures throughout Victoria’s health system, the new nursing ratios could lead to further budget constraints elsewhere, such as planned surgery capacity.

Health services are already, as many members in this place know, under enormous financial strain. The latest health service annual reports reveal cumulative operating losses across 68 health services exceeding more than $1 billion. The Peter MacCallum Cancer Centre has 0.48 days of available cash in the bank, a significant way off its target of 14 days. Peninsula Health has no days of available cash, and some services have negative days of cash on hand and available. Last year major hospitals implemented hiring freezes after being asked to cut costs by the government, and who could forget the leaked email from the then CEO of Alfred Health, who said that the budget was so dire that there was a suggestion made that staff cut costs by turning lights off when they leave a room.

Belinda Wilson interjected.

Brad ROWSWELL: Member for Narre Warren North, it is not a bad point at all, but it actually demonstrates the desperation of the government’s budgetary position that you have got the CEO of a major health network suggesting the lights be switched off in order to save a bit of coin. That is indeed a desperate circumstance. Before the government stepped in –

A member interjected.

Brad ROWSWELL: Acting Speaker, I promise I will no longer take interjections from government members. Before the government stepped in with an emergency –

A member interjected.

Brad ROWSWELL: Well, better than lights on and no-one home on that side of the chamber, isn’t it? Whistleblowers revealed that the following health services were on the cutting table: closing special care cots needed to treat sick kids, bed closures escalating to full ward closures, cutting BreastScreen services, closing satellite dialysis units despite record demand et cetera. And we do have legitimate concerns over workforce demand. Australia is facing a shortage of more than 70,000 nurses by 2035 according to national projections revealed in the Commonwealth’s 2024 Nursing Supply and Demand Study. In the bill briefing the Department of Health was asked about the extent of the additional workforce required. They were unable to provide a figure, which is deeply concerning indeed. The department was also asked in the briefing which hospitals had not been able to meet the existing ratios. This was taken on notice, but to date no response has been received. Additionally, when asked if modelling on the impact on the broader health workforce of this bill was carried out, especially given existing nurse shortages, the Department of Health said that they ‘left it to health services to review their operational capacity.’ That sounds to me like that is an absolute and utter casebook definition of passing the buck, which demonstrates in my view that the Minister for Health and her department have decided to press ahead with this bill with an incredibly poor understanding of the facts on the ground and the consequences of their actions.

Now, as I said earlier, we support the bill. We support the intent of the bill. We want the intent of the bill to succeed in Victoria’s health system, because if it does, then Victorians in theory at this point do get a better health service, but it is important to do your homework beforehand and not just pass the buck to bureaucrats when it comes to questions about the financing of these new capacity requirements and the staffing of them as well.

In the time I have remaining I do wish to draw upon my own local hospital, Sandringham Hospital, which I have spoken about quite fondly in this place over many years now. Sandringham’s emergency department treats more than 50,000 patients every year, with around 20 per cent of those patients being children, who commonly present with broken or fractured bones. I am pleased to inform the house that the federal government has recently granted Alfred Health an MRI licence for Sandringham Hospital, and this MRI licence if brought into reality will actually assist with the diagnosis of patients and be able to get them better care and quicker care at Sandringham Hospital itself. There is no MRI there at the minute, and that is of deep concern to me. I do know that the former federal member for Goldstein, who just happens to be the Liberal candidate for Goldstein at this federal election, Tim Wilson, wrote to the then health minister in December 2018 saying to the then health minister, ‘Health Minister, we desperately need an MRI licence for Alfred Health at Sandringham Hospital.’ So the story of this advocacy has been very, very long, and I give credit to the former Liberal member for Goldstein Tim Wilson in his advocacy dating back to 2018.

So there is a demand for it, and clearly the current federal government have acknowledged that there is demand for it, because they have now granted that licence. I was informed by the current member for Goldstein of that circumstance only recently. The only thing standing in the way of a new MRI facility becoming a reality at Sandringham Hospital is the state government, because the federal government provides the funding for the licence and the ability for their MRI services to be bulk-billed.

It does not pay for the engineering and it does not pay for the infrastructure, nor the MRI machine itself. That is a state government responsibility. So I use this opportunity, speaking on the safe patient care bill 2025, to say to the government and to say to the health minister: please, please – this federal government funding is available from 1 July this year – on behalf of my community, I plead with you to do everything within your power to provide, in May’s state budget this year, the $3.5 million of state government funding that is required to make that MRI machine at Sandringham Hospital operational as soon as it possibly can be. It is the right thing to do. The federal government have acknowledged that there is a need for it, because I think there is around $16 million in funding which they will provide as of 1 July this year. We are simply asking for $3.5 million from the state government.

I had a very brief conversation with the health minister about this just the other day. I am aware that she is aware of the request. She knows about it. That is a really good start, and it provides a level of confidence for me and my community. But what we really need is for the state government to provide that $3.5 million to get this Sandringham Hospital MRI operational as soon as we possibly can, because that licence kicks in on 1 July this year. My community only deserves the best.

Chris COUZENS (Geelong) (11:06): I am very proud to rise to contribute to the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Bill 2025, and I want to start by thanking the Minister for Health for her work on this significant bill. It is so important that we continue to provide the best possible areas for our nursing and midwifery community. I do want to thank and acknowledge the nurses and midwives right across this state for the work that they do. We know our health system is built on the skill, dedication and compassion of Victoria’s nurses and midwives. We also know that nursing and midwifery is a female-dominated workforce. As we lead into International Women’s Day, I want to celebrate our nurses and midwives and acknowledge the essential role that they play in our community whilst also juggling the many other expectations of women in our community. I wish them a very happy International Women’s Day on Saturday.

I also take the opportunity to acknowledge and thank the nurses and midwives at Barwon Health University Hospital in Geelong. Barwon Health has over 8500 staff, with many who are nurses and midwives working in maternity, mental health, aged care, cancer services, community health, palliative care, hospital services and so much more. They work hard for us every single day. The new ratios will see improvement in ICU, resuscitation and midwifery at Barwon Health. I also want to acknowledge and thank Barwon Health’s Aboriginal health unit, headed up by Renee Owen and her amazing team.

As we know, it was particularly true during the pandemic that our nurses and midwives not only worked very hard but put their own health at risk to ensure that every Victorian got the health care that they needed. They did work incredibly hard to keep us all safe, and they were putting their own health at risk, as I have said, and that of their families. Going in to work every day, they risked their own health and that of their families by working long hours and caring for very unwell people with COVID as well as dealing with the usual everyday demands of the health system. That is why at the 2022 election the Labor government committed to further protect and strengthen the ratios. We committed to this because it is what our nurses and midwives told us they wanted and needed. With this bill we are delivering on those commitments. Our healthcare workers know only Labor has their backs. We are proudly the party of nurse-to-patient ratios.

In terms of the bill, the nurse-to-patient and midwife-to-patient ratios were first introduced in 2000, but the former Liberal government tried to force nurses to trade them away as part of their enterprise agreement negotiations. This is why in 2015 under the Labor government Victoria became the first state in Australia to enshrine nurse-to-patient and midwife-to-patient ratios into law.

The new ratios are the result of extensive consultation with nurses and midwives, the Australian Nursing and Midwifery Federation and health services and will be set in stone.

The one-to-one nurse-to-occupied-bed ratio in ICUs on all shifts for all level 1 and level 2 hospitals mean that every occupied ICU bed will have a dedicated nurse assigned to it at all times. ICUs will also require a team leader and liaison nurse for the very first time and improved staffing ratios in resuscitation cubicles in EDs on morning shifts, bringing more shifts in line with afternoon and night shifts; a one-to-four midwife-to-patient ratio in postnatal and antenatal wards on night shift, down from one to six; and an in-charge nurse on night shifts in standalone high-dependency units and coronary care units. To ensure the health services are adequately supported and prepared to action these changes, the amendments will be rolled out in a staged approach, with 25 per cent of the additional staffing implemented the day after royal assent, 75 per cent from 1 December 2025 and 100 per cent from 1 July 2026.

Our government committed $101.3 million in the 2023–24 budget to support the implementation of the new ratios. The new ratios build on the Labor government’s 20.4 per cent pay rise for our hardworking nurses and midwives, helping to retain and recruit more nurses so more Victorians can get the best care. Through this historic deal we are also recognising the historic undervaluing of this highly feminised workforce – an important step towards gender wage equity in Victoria.

In addition to the wage increase, the new agreement backs our existing workforce and encourages a new generation of nurses and midwives by delivering preserved longstanding career structures and opportunities for progression. It incentivises permanent work through a new change-of-ward allowance, which will compensate nurses and midwives when they are moved from their base ward; improves night shift penalties for permanent nurses and midwives and includes a right-to-disconnect clause; improves access to flexible working arrangements, recognising that nurses are available 24/7; and reduces the qualifying period for parental leave from six months to zero in recognition of the service of interstate public service nurses and midwives who have relocated to Victoria. Of course we want Victorians to choose nursing and midwifery as a career. We need them. But we must look after them as well, and that is what this bill does.

In Geelong we have the new women’s and children’s hospital currently underway, and this is a real game changer in my community of Geelong. The community is very excited about that. We turned the sod only a couple of weeks ago, and it has now commenced. But we need nurses and midwives working in there, and I think this gives them great confidence to take up roles in things like this new hospital, thanks to the Allan Labor government. We have also invested in the new children’s emergency department at Geelong hospital. I recently opened the drug and alcohol mental health hub in central Geelong. We have opened the acute mental health facility. We are about to open youth mental health beds that are currently under construction – a first in Geelong. Currently young people are sent to Melbourne, so this is a real game changer for our community. Of course there is also the early parenting centre that recently opened.

All those areas require nurses and, in some cases, midwives. This bill is encouraging people to go into a nursing or midwifery career. It gives them confidence that they will be earning the right wages but also receiving the conditions they need to be able to deliver the best possible health care in our community. What has been delivered in Geelong is unprecedented in terms of health. I am very proud of that and as a government we should be very proud of that. But we must also remember that it is the people in those buildings doing the hard work. They need our support, which is, again, what I said. This bill gives them confidence that we do respect the work they do and we do care about the very important role that they play in our community.

Since coming to government we have grown our healthcare workforce by nearly 50 per cent, and some of that is in my community of Geelong. There are an additional 40,000 nurses, midwives, doctors, allied health professionals and other hospital staff in the state’s health services. Almost one in four of these new roles have been created in rural and regional Victoria. As I said, many of those are in my community, and there will be many more to come once the women’s and children’s hospital is ready to open. 2028–29 is the expected completion date, and we need to have those nurses and midwives in that hospital ready to go at that time.

Almost one in four of the new roles have been created in regional and rural Victoria, and that is really significant. We hear those opposite complain that they do not think they are getting enough in particularly regional and rural areas, but the proof is in the pudding. The data is there to indicate that we are doing these things right across regional and rural Victoria. There are now 45 per cent more nurses and midwives in – (Time expired)

Wayne FARNHAM (Narracan) (11:16): I am pleased to rise today to contribute on the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Bill 2025. I am very pleased to follow the member for Geelong, because I just might correct her on a couple of things. But I will go into the bill first. We do not have an opposed position. Come back, member for Geelong. Do not run away. We have not got an opposed position on this bill, and we will not oppose anything when we are talking about patient care.

We are not going to oppose anything to do with patient care, but we do have concerns around the funding. We saw that with funding just last year, when health care needed another $1.5 billion pumped into it, and I am pretty sure the minister went begging to the Treasurer at the time to ask for that money. It seems to be that funding is becoming very problematic in our healthcare industry. We see that with WorkCover premiums, for example, and I will reference the West Gippsland Hospital on this. That WorkCover premium was raised 100 per cent. That could have employed another four nurses, that uplift – probably more, actually. It was nearly $900,000 their WorkCover premium went up. I am assuming that probably seven extra nurses could have been employed with that amount of funding.

We just heard from the member from Geelong. She talked about regional health care. It is interesting. I do get really sick and tired in this place when I hear about the constant pork-barrelling from this government. It gets me quite angry. I have heard the member for Geelong just now talk about how great it is her hospital is being built. That is fantastic. We will probably hear from the member for Footscray later. She will say how great the investment in their hospital is – fantastic. The member for Frankston will mention it as well, and the member for Melton will mention it. The thing is: they are all Labor seats.

Members interjecting.

Wayne FARNHAM: My point to this is – and members on that side can shout at me all they want, I do not mind; I am going to make this point: why are the people in West Gippsland and Narracan less important than people in Footscray, Frankston and Geelong? Why are they less important?

Vicki Ward interjected.

Wayne FARNHAM: The minister is sledging, and I am very happy to take her up on her interjection, because facts matter. For the people of West Gippsland this government committed to building a hospital and to start the construction in 2024. It is now 2025. No early works have been done. We are talking about a hospital that was built in 1939. Why are the people of West Gippsland any less important than anyone else in this chamber?

A member: They are not.

Wayne FARNHAM: They are not. The minister just said they are not, and I agree 100 per cent.

A member interjected.

Wayne FARNHAM: Someone said they are not. Do not worry; I heard it. I heard it from somewhere. It might not have been the minister; it might have been from somewhere else. But my point is: this government did say they would govern for all Victorians, so why wasn’t my hospital started when the government said it was going to start?

This hospital, again, was built in 1939. Yet there seems to be a priority for hospitals in Labor seats rather than coalition seats. There seems to be a priority for hospitals in Labor seats now. My community has been the fastest growing community in Australia over the last decade. It has had a population increase of 48 per cent over the last decade. It has been reported quite widely as the fastest growing community in Australia, so why is the government continuing to delay the delivery of this hospital? This bill is about patient care.

Now, those opposite that are sledging me, I doubt they have walked into West Gippsland Hospital, let alone driven past it. To be perfectly honest, unless you have been there, unless you have talked to the staff, do not interject, because you do not know the condition of the hospital. Not one person over there would know the condition of West Gippsland Hospital – not one.

A member interjected.

Wayne FARNHAM: Have you been there?

A member interjected.

Wayne FARNHAM: Yes? Good. You probably drove past it on the way to Lakes Entrance. That would be my guess. This government, to get back to the promises, were saying, ‘We deliver for all Victorians. We’re going to start building this hospital in 2024.’ There was no uplift in last year’s budget, so nothing has happened. I doubt very much that there will be uplift in this budget to start the construction of the West Gippsland Hospital. I doubt it very much. When is it going to start? I asked in an adjournment in last November for the Minister for Health: when will the hospital start? It is a very, very simple question. That still has not been responded to. Just be honest with the community of West Gippsland. That is all I am asking. Be honest: when will the hospital start? Surely this government that has been in government for longer than a decade has a plan for this hospital. Surely the minister can tell me when it is going to start. Is there going to be an uplift in the 2025–26 budget to start construction? It is a simple question: yes or no? If there is not an uplift in that budget, then it is not going to start till 2026. That is two years behind the commitment. This hospital is probably one of the greatest needs in Victoria.

When we talk about nurse-to-patient ratios, they cannot achieve that at the moment. No matter what you say, no matter what you do, no matter what bill you put in, no matter what bill you pass through this Parliament, if you do not invest in the infrastructure, particularly for West Gippsland Hospital, how are you going to achieve the targets? It is a commonsense question; it is a commonsense statement. It is what I am asking the government. We have had a litany of broken promises from this government when it comes to health care, no more so than when we talk about the big announcement in April 2020 when they were going to deliver another 4000 ICU beds. The Premier at the time, Daniel Andrews, got up there and said, ‘We will deliver 4000 ICU beds.’ Seventeen months later they walked back that promise. That did not happen. It was never mentioned again after September 2021, and actually the minister at the time, poor Minister Mikakos, got thrown under the bus by the Premier. This government has history on breaking promises and no more so than in the health industry.

We do not oppose this bill, and as I said, we do not oppose anything when it comes to patient care. But for goodness sake at least deliver on what you said you were going to do. For my community at the moment the hospital is in such poor condition, but this government continues to delay it. I do not think that is fair for West Gippsland, and I will keep shouting at this government to deliver it. Last November I talked about my experience in that hospital when my father died. It was a very traumatic experience for my family, and I know other constituents in my electorate will have to go through the same thing. I will say to the government what I said back then: keep your integrity intact and build the hospital. It is not hard. Get the cows off the site, get the excavators on the site and start the early works, whether that is bringing in the sewer main or whether that is bringing the water across the road.

The services are there; the works just need to be done. Bring an uplift in this year’s budget to fund the West Gippsland Hospital. It is really simple. You have got a community now where it is the number one issue. I do not think the people in West Gippsland should be treated any differently from anyone else in this state. The government just has to keep its promise. That is all I am asking.

If the government keeps its promise and builds the West Gippsland Hospital and wins the seat of Narracan because they did that, power to them. Good on them; they kept a commitment. But my community is not seeing it. Here is a challenge for the government: put your political capital against mine. Build West Gippsland Hospital. Give something to the people of Narracan they can actually cheer for. Get the excavators on site and start the construction. My community deserves to be treated better than what it is at the moment. Every election commitment they came forward with in 2022 they have broken. Do not break this one. Deliver the hospital. Put your political capital against mine and see how we go in 2026.

Eden FOSTER (Mulgrave) (11:26): I am pleased to rise today in support of the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Bill 2025, and I thank the Minister for Health for her hard work on this bill as well as all other members of the government who have contributed to the development of this legislation.

Following on from the member for Narracan, I like to see his passion for his community, but I also remind those opposite that if you just do a quick Google search on nurse-to-patient ratios under the Kennett government you will see that they were decimated. You will see that in the 1990s the nursing force was decimated. It just goes to show that perhaps there are cuts in their DNA. It might have been the last millennium, but that is because the Victorian people want to vote for a Labor government because we actually act on health. I know when I was younger and my mum needed to go to hospital for treatment the wards were closed because of the Kennett government. So if you talk about caring for patients, we are doing something about it. I get that those opposite care about their communities, but I just want to remind them that previous governments did not feel the same way and we are acting on that.

Victoria’s public health system is one of the strongest in the world because of a Labor government. We have the interests of patients and professionals at heart. This bill seeks to create a better state of affairs for both of those groups – the carers and those they care for – by delivering on a commitment this government has been championing since day one. By strengthening and protecting nurse-to-patient and midwife-to-patient ratios, this government will reduce the stress, workload and toll on our healthcare professionals. At the same time, patients will get more time and attention from their carers, thus increasing the standards of safety and quality in patient care that Victorians can expect and deserve the next time they find themselves requiring hospital care.

Nurses and midwives are the backbone of our healthcare system. In Victoria 50,000 professionals work day in and day out to provide for our sick and ailing, caring for our ill, our elderly and our youngest, bringing new life into the world. They are patient focused, empathetic, tenacious and constantly dedicated to providing individualised care which is right for their patients, because no two Victorians are exactly the same. I should know, having undergone treatment for lymphoma and receiving the best care from the nurses at Peter Mac. I want to give a big shout-out to the nurses in our healthcare systems across our state. They do a fantastic job, and I received their fantastic care. They are patient and they are understanding. We know that they are overworked, and that is why this nurse-to-patient ratio that we are working on will help them.

Striking the balance between empathy and professionalism is incredibly challenging, yet the remarkable work of these professionals has earned them the distinction of being the most trusted professionals in Australia. I bring these facts to the attention of the house because they demonstrate the strong case for providing the best possible working conditions for all nurses and midwives in whatever capacity or discipline they practise. This bill will do just that.

The Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Act 2015 has been successfully improving the state of care in Victoria for nearly a decade now. Our wards and care units are safer, more supportive and more productive than they were before this act, and this improvement has only been strengthened as further phases in the Andrews–Allan plan to build better patient care in Victoria have been enacted. In addition to the original act’s minimum workload protections, changes in 2019 and 2020 led to an additional 1100 nurses and midwives being employed in a range of general and specialist disciplines.

This proposed amendment presents a further third phase of improvements aimed at better staffing ratios in some of the most intense and important departments in health care. To avoid doubt, we are talking about intensive care units, coronary care units, high dependency units (HDUs) and emergency departments. At the risk of stating the obvious, these are places where nobody wants to be. Having said that, in the unfortunate event we do find ourselves in these wards, we want the reassurance that there are enough professionals on hand to give us the time and care we need to get back to as normal as possible as quickly as possible. As someone who was involved in health care myself, like I said, both as a patient at Peter Mac but also as a past employee at Monash Health, I know better than most about having more staff, more professionals to share the load. It is crucial in ensuring that the best quality of care is given to those who need it most, and this bill is a material step in that direction.

To talk specifics for a little bit, I applaud the commitment that this bill will introduce staffing ratios of one to one – that is, one patient to one nurse in intensive care units at levels 1 and 2. This means that those with the most critical conditions will not be left unattended or without the necessary care that will give them the best possible chance of recovery. Similarly, the commitment to improving staffing ratios in postnatal and antenatal wards by entrenching a one-to -our night shift ratio is a great step forward and ensures all Victorians have the best possible support on hand for the birth of their children no matter what time of day. Finally, the fact that these changes and many more besides, as featured in this legislation, are to be 100 per cent implemented in less than 18 months is a remarkable effort which demonstrates this government’s wholehearted commitment to providing and maintaining the best healthcare system it possibly can.

As I have been considering this bill and the impact it will have on Victorians from all corners of our great state, I have been drawn to the new and growing families in my electorate of Mulgrave. I have met families who are excitedly awaiting the arrival of new children, and, as is always the case, that excitement is coupled with nervousness as they look toward the big day: will it be a healthy child? Will the birth be complicated? What if I do not have the care I need? The idea that, because of the support this bill provides and the votes we cast in favour of it, those constituents and all those like them across the state will have easier access to quicker care and with fewer other patients competing for their assistance is genuinely exciting and fulfilling for me as a legislator. The same applies to the ill and the ailing in ICUs, CCUs and HDUs. The fact that lives will be saved or at least made more comfortable by the staffing changes this bill will bring to our hospitals is equally edifying.

Furthermore, it is genuinely nice to know that should any family member or friend end up in these wards fighting for their lives, they will have the care and attention that we would want them to have and that they deserve. It is reassuring for us as Victorians to know we have a strong healthcare system to fall back on should things go wrong, and with these amendments that reassurance will only grow. More professionals means better care, more immediate attention and more positive outcomes.

While those on the other side have a history of cuts to health care and nurse-to-patient ratios, we in the Allan Labor government support our nurses, support our midwives, support our patients and support our Victorians. I commend this bill to the house.

Danny O’BRIEN (Gippsland South) (11:35): I am pleased to rise to speak on the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Bill 2025. Like previous speakers, I would like to acknowledge, firstly, that we are coming up to International Women’s Day. Though this legislation is not specifically about women, clearly most of our nurses and midwives are women, and I acknowledge the work that they do, including those in my family. Members of my extended family are nurses and midwives, including a number of my aunties and cousins, who the minister at the table, the Minister for Emergency Services, will be pleased to know are members of the Australian Nursing and Midwifery Federation. Some of them quite strong members of the ANMF and give me a bit of grief on social media from time to time. I am talking to you, Aunty T and Nicky. I acknowledge all of those in the health services for the work that they do and thank them for the care that they provide to all of us each and every day. I acknowledge too that they have had a pretty rough time of it over the last five or six years and even prior to COVID, but through the pandemic times things were particularly tough.

I want to just take up the last point the member for Mulgrave was finishing on and highlight not just the member for Mulgrave but many members. I see the member for Pascoe Vale is here as well, so I will give him a shout-out too, given his commentary on the matter of public importance yesterday. There has been a lot –

Katie Hall interjected.

Danny O’BRIEN: The member for Footscray is desperately asking to be referred to. She knows that the Nat vote carries a fair bit of weight in Footscray and she likes me to give her a mention. Those opposite this week have often been talking about cuts and saying it is only the coalition that cuts. I have been quite astounded. Did they not see the CPSU on the steps of Parliament this week? Have they not seen the Treasurer’s announcement of 3000 jobs to go? Now, I am not arguing against necessarily some efficiency in the public service, but the hypocrisy of those opposite! Ask the fisheries department how they are going with cuts at the moment. Half of the fisheries officers in the state have been sacked in the last week or so by this Labor government, so it is a bit rich to come in here and say, ‘We build up our health services. We build up our public services. They only ever cut.’ You are the ones cutting right now. They have completely lost control of the budget because Labor cannot manage money, and that goes to an important point about this legislation on the nurse-to-patient and midwife-to-patient ratios.

We are not opposing this bill, as we have not opposed previous bills with respect to the ratios, because we certainly support trying to improve the level of care that is provided to Victorians and at the same time reduce the burden and the stress on healthcare workers, particularly nurses in our hospitals. The concern that we always have, which the government never seems to actually address, is the impact of that on hospitals and whether that is funded. It is all well and good to go and stand next to the ANMF and say you are introducing these ratios, but if you do not then fund them properly, what does that do to patient care throughout the hospital? What happens if the hospital goes broke? That is seriously one of our concerns.

This legislation is the third phase of the nurse-to-patient ratios promised by the government as an election commitment in 2022. We acknowledge that. It introduces higher minimum staffing levels in intensive care units, in high-dependency units, in coronary care units and in emergency departments at varying levels depending on level 1 and 2 hospitals. Again, this gets to the crux of what government is all about. It is about making decisions. We would all like to have our roads perfectly manicured and maintained. We acknowledge we cannot have that perfection. We would all like to have every kid achieving at the highest level in education, and so we put more money into teachers and into schools. We would all like to have no bad outcomes happen in hospitals – of course they do happen from time to time as a natural factor – but we have seen recently some significant issues, particularly in my neck of the woods at Latrobe Regional Hospital, with sentinel events that have been quite frankly out of proportion and a concern.

The point I am getting to is: you could put the entire budget into some of these areas and that would lead to unintended consequences elsewhere, and so it is with this legislation. It is important that the government understands if it is going to do this it needs to actually fund the hospitals to pay for it, because ultimately the hospitals have to be financially solvent, and it is a concern to us over time. I am sure if members of the government have talked to their hospital executives at any stage, they will have heard the concern about this in the past with previous ratios that have been introduced.

The government has suggested that it has allocated $101.3 million to implement the increased staffing levels, but it has not been able to provide where that is in the budget. I am reminded of a previous minister in one of my first Public Accounts and Estimates Committee attempts. The Minister for Emergency Services at the table might even remember, because she was there too. I asked where this commitment, which in fact was on roads, was: ‘Minister, where’s this commitment on roads?’ He said, ‘It’s in the budget.’ I said, ‘Whereabouts?’ ‘It’s in the budget, Mr O’Brien.’ I said, ‘Yes, but what specific line item? What section? What output is it in?’ He said, ‘It’s in the budget, Mr O’Brien,’ and we are sort of getting the same answer on this one. This money is in the budget but there is no line item for it, there is no detail, and that is the concern – that while it is absolutely great, and patients and nurses will welcome having more resources, it does need to be funded, and that needs to be provided.

We know that our health services are already under significant strain. We saw that last year. We saw the government have had to commit an extra $1.5 billion to keep the system operating. We know that many of our major hospitals and indeed some of our smaller ones are operating in deficit and struggling to pay staff and bills on time. So it is unclear to us whether the government is providing enough.

The second question with this is the workforce capacity. Anyone in the health system will tell you – particularly those nurses – that it is a struggle to keep them in the system and a struggle to attract them. I know the government likes to talk about how many nurses and medical professionals it has employed, but it is interesting. I last year did a little bit of research after the minister told us that there has been a 50 per cent increase, I think the figure was, in nurses under this government. That is nice to know. What I then had a look at is the Department of Health annual reports, and since this government came to power there has been an increase in the total workforce in the health department of 152 per cent and an increase in the budget for the health department of 74 per cent, but there has been an increase in senior executives of 425 per cent. I do not know whether that is executives who have got to calculate whether the nurse-to-patient ratios have been delivered or not, but if you wanted to know –

Vicki Ward: How many people? How many actual people?

Danny O’BRIEN: Well, it is a significant number. I can actually tell you that if I have got it here: it has gone from 39.5 full time equivalent to 207.4, so it is a significant increase. If we were interested in actually delivering frontline services on the ground, we would be putting those sorts of resources into the nurses and into the doctors and health professionals in our system. And I would hope that perhaps the CPSU might be complaining and saying to the Treasurer that some of those executives should be on the chopping block early on before anyone at the front line is as well, because that is the sort of waste and mismanagement that I think we have seen under this government. As I said, the workforce capacity issues are still there, particularly for nurses and for midwives as well. Again, if you talk to your hospital CEOs and executives – and I know do fairly regularly – it is always a challenge finding them. Particularly in rural areas it can be very difficult. But it is a challenge, and it is up to the government to answer that.

The shadow minister in the other place Ms Crozier actually asked in the departmental briefing which hospitals have not been able to meet the existing ratios, and that was taken on notice and we have not got an answer to it. We are still asking if there has been modelling done on what the impact on the broader health workforce will be of this initiative. Again, it is all well and good to say you are going to introduce these ratios; you have actually got to have the nurses and midwives to fill those positions. I am very happy to accept that there will be aspirations, but this is actually putting it in law, this is not an aspirational target.

Again I would like to thank all our nurses and midwives for all the work they do in keeping us safe and well and treating us in our time of need. But I do caution that this government have form on not actually funding these reforms properly, and I am concerned that they will do so again.

Josh BULL (Sunbury) (11:45): I am pleased to have the opportunity to make a contribution on the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Bill 2025. There seems to be an unusual pattern over the last few sitting weeks where I follow the Leader of the Nationals, and you, Acting Speaker Mercurio, are in the chair. I do not know why that continues to happen, but there you go. As I said, I am pleased to have the opportunity to make a contribution to what is a very important piece of legislation when it comes to health care in our state and of course to stand, as we continually do, with those incredible nurses and midwives who make such an important contribution to health care right across the great state of Victoria. We know and understand that working with those that support us in our greatest time of need is indeed something that is critical to the work of this state, to the fabric of our community and indeed to the power of work that gets done no matter where you live right across our state.

There have been significant investments made by this government over the past decade. I just want to reference some of those before outlining some of the changes that are contained within the mechanics of this bill that go to ratios. What we know and understand is that with a growing population, with investments such as in Footscray and in the new hospital in Melton, the investments at the Austin and the investments that are going to be made in the Northern Hospital, these are of course going to be supporting growing communities and better health care and supporting our nurses and our midwives and the entire healthcare system, which, Acting Speaker, as you know and all members know, has of course since 2020 and 2021 been under immense pressure due to a global pandemic.

Certainly, in making some reflections on those times, what I know I am particularly proud of as a member of this government is that each and every day through some of those darkest times and toughest hours we on this side of the house always stood by those who stood by us and indeed followed the science, listened to the science and listened to the experts. Unfortunately, we have a show over on the other side of the chamber that just seems to have put those matters aside, and they certainly come into this place and often provide interesting lectures and look back through a different lens on those times. But I think the vast majority of people in this state, the vast majority of Victorians, know and understand the importance of science, the importance of investment and the importance of listening to people that have spent their entire lives studying and working hard in what is a very complex profession.

This bill builds on work that was done in 2015 around ratios and indeed goes to making sure that we are continuing to deliver on the commitments made in 2022 to further protect and strengthen such ratios. We know that the nurse-to-patient and midwife-to-patient ratios were first introduced in – I mentioned the date – 2015, making sure that we enshrined the nurse- and midwife-to-patient ratios into law. I was here at the time. It was indeed a very important step, and this next step of course builds on that, introducing stronger and safer ratios and ensuring the very best care for Victorian patients and their families.

The new ratios are a result of extensive consultation with nurses, midwives, the ANMF and health services to set in stone one-to-one nurse to occupied bed ratios in ICUs on all shifts for level 1 and level 2 hospitals, meaning that every occupied ICU bed has a dedicated nurse assigned to it at all times; ICUs require a team leader and liaison nurse for the very first time; improved staff ratios for resuscitation cubicles in EDs on morning shifts, bringing morning shifts into line with afternoon and night shifts; a one-to-four midwife-to-patient ratio in postnatal and antenatal wards on night shifts, down from one to six; and in addition to that, an in-charge nurse on night shifts in standalone high-dependency units and coronary care units. To ensure that health services are adequately supported through such changes, the amendments are to be rolled out in a staged approach, with 25 per cent of additional funding implemented the day after royal assent, 75 per cent from 1 December 2025 and 100 per cent from 1 July 2026. There is some detail in those changes, but this essentially goes to building on the work that was done in 2015 and building on the investments that have been made in health care to provide for the very best of care.

I am taking the opportunity, as others have done, in the 3-odd minutes that are remaining to thank the wonderful healthcare workers within our communities right across the state, particularly within my electorate. Having the opportunity, as I am sure all members do, to speak to our healthcare workers and to understand the importance of the work that they do and to put on the record an acknowledgement of and a thankyou for the wonderful work that is done is something that I wish to do. Having, as I am sure others do, a number of nurses within my own family – my sister being one of those – I take the opportunity to thank her and extended members of the family for the incredible work that is done.

Making sure that we are providing the infrastructure within growing communities, within regional communities, right here in town and right across the state is something that is incredibly valued by and important to this government. Making sure that we are investing in staff through both legislation such as this and other programs and initiatives is a very important matter. Buildings and space and modern facilities are terrific and are very important to the healthcare system, but every member of this house should know that the healthcare system is made up of the incredibly hardworking men and women who go to work every day to support those who need health care. It is something that we should constantly keep in the forefront of our minds. Constantly reminding ourselves of the night shifts for ambos and their time on the road and of those that work right through, 24/7, 365 days a year, to support us and our loved ones is something that is very important. Building on those ratios, making sure that we are supporting the science and the investment and the research, is something that is really important. There is a large array of programs and initiatives both in medical research and in broader investments across the healthcare system that we have made.

But as I say often, member for Footscray, the work is not done. It continues every single day. The healthcare system faces challenges. There are a whole range of challenges within every hospital setting every single day, and I know that the Minister for Health, the minister for medical research and the entire team are working incredibly hard with the department. But I go back to where I started: at the very centre of this, at the very core of this debate, is the recognition that our nurses and midwives do incredibly important work within our community. Having in the Parliament this debate today further builds on that work and that recognition. Making sure we are supporting those people to do the very best work is something that this government is proud of. With those comments I commend the bill of the house.

Annabelle CLEELAND (Euroa) (11:55): I rise today to speak on the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Bill 2025. It is a bill that we do not oppose. The bill starts the third phase of legislation initially introduced by the Andrews government back in 2015 that established minimum staffing levels for both nurses and midwives within the Victorian public health system. Since then there have been two phases of amendments to ratio requirements – first in 2019 and again in 2020. Previous amendments over the last five years include increasing patient ratios in specific settings, including stroke, haematology and oncology wards; palliative care; aged care; and birthing and emergency departments.

The changes to the current ratios include the following. In level 1 and level 2 ICUs a one-to-one nurse-to-patient ratio will be mandated for all occupied ICU beds on every shift. ICUs will now require team leaders, liaison nurses and a nurse in charge of the unit. Each resuscitation cubicle in emergency departments will need a one-to-one nurse-to-patient ratio, which is an improvement on the current one-to-three ratio. In level 4 services that are part of larger metro hospital and in levels 5 and 6 services under the maternity capability framework a one-to-four midwife-to-patient ratio will be implemented on night shifts in postnatal and antenatal wards, improving on the current one-to-six ratio. And an in-charge nurse will be added to night shifts in standalone high-dependency units and coronary care units.

Today’s legislation establishes high minimum staffing levels once again, with new ratios set to be introduced in emergency departments, intensive care units, high-dependency units and coronary care units. The changes aim to improve both patient care and safety by creating legislative requirements for more nurses and midwives across our health system – and we agree. While this bill has the right intent, I have to ask: what good are mandated ratios when the hospitals they apply to are crumbling under the weight of a broken system? What good are promises of better care, when patients are left suffering and, in tragic cases, losing their lives due to the failures of this government? What good are mandated ratios when we do not have the workforce to fill them?

Just this week we were confronted with yet another devastating loss in regional Victoria. A man lost his life after waiting for 5 agonising hours in a ramped ambulance at Albury Wodonga Health – 5 hours. This is not an isolated incident. This is the grim reality of health care in regional Victoria under the Allan Labor government. Statewide ambulance transfer performance for October to December 2024 remained stagnant at under 70 per cent – far short of Labor’s promised 90 per cent target. Instead of fixing the root causes in our health system, the government’s response has been to punish hospitals already struggling under immense pressure. With inadequate resourcing, forced hospital amalgamations, service cuts and overworked paramedics, the Minister for Health has chosen to shift blame rather than implement real solutions. Without systemic reform, expanding hospital capacity, improving staffing levels and streamlining emergency department processes, these failures will continue. This is what happens when a government prioritises spin over substance, bureaucracy over patient outcomes and neglect and ignorance over action.

Let us be clear: the people of north-east Victoria – the people of regional Victoria – are not staying silent. They are not accepting these failures. This week 300 people travelled from across our region, representing councils and communities, demanding better investment in Albury Wodonga Health. They are fighting for a new purpose-built hospital on a greenfield site, a project that would save lives and improve health care for generations. But what do they get from the government? Gaslighting, lies and deflection. The Minister for Health refuses to listen or even meet with these people. When challenged in the chambers about this, those on the other side were quick to blame members, such as me, with baseless accusations in order to ignore the main issue.

The minister refuses to support the project and has been nothing but dishonest. How can you be listening to the needs of the community when most of those in it have been protesting these very decisions? The hypocrisy is staggering. The minister refuses to take responsibility while our health system collapses around her.

Labor once again stands here touting supposed improvements to patient care while simultaneously cutting funding, gutting services and leaving regional Victorians behind. Just this week in the Legislative Council Georgie Crozier asked the Treasurer a simple question: could she guarantee that there would be no funding or services cut at smaller regional hospitals? The response? Silence – a full 20 seconds before the Treasurer sat down without an answer. That silence speaks volumes.

This government is gutting regional health care. It has allowed maternity services to close in Benalla, forcing expectant mothers to travel hours for care. It has driven Kilmore’s maternity health services into restricted operating hours, leaving women without local options. It has overseen hiring freezes and funding cuts that have stripped Wangaratta of midwives and gutted the midwifery group practice program despite an increase in demand. What kind of a government is this? What kind of a government looks a pregnant woman in the eye and tells her to drive several hours in labour because local hospitals cannot care for her? It is not just maternity care; it is every aspect of regional health care.

The Allan government’s so-called Health Services Plan is set to centralise our hospitals, stripping local facilities of autonomy, reducing services and forcing patients to travel further for care. This is not a plan to improve health care, this is a plan to abandon regional Victoria. I think of people like Allan, a Benalla resident who needed transport to Melbourne for an appointment regarding his pacemaker. No patient transport was available. His only option was a taxi for several hundreds of dollars. How many people can afford that at the moment? How many are suffering in silence because this government refuses to provide even the most basic healthcare infrastructure?

These issues cannot be blamed on a lack of trying by our local health services providers. For example, the Royal Flying Doctor Service, a community patient transport team, have been requesting crucial funding – they run out in June – making excellent proposals based on volunteers. It is not a lot of money. Despite incredibly modest requests, the government has again failed to listen to them and provide this critical funding.

I want to do a quick stocktake of what the current state of our health system is under Labor, just to explain how our communities and I are viewing the work this government does. Labor has forced our hospitals to merge. Labor has stripped local voices away from our services. Labor has made regional patients travel further from home to access these services. Labor has left our regional maternity units at bare bones with a hunting licence on those remaining services called the regional maternity taskforce. Labor has failed to support patient transport services while forcing dialysis patients to find their own way to care. Labor has left our ambulance and 000 systems in shambles as pay disputes, missed targets and a lack of resources continue. Labor has left people in pain as surgery waitlists skyrocket. Labor continues to gaslight and lie to our healthcare providers and our communities. I am sure there are many more examples I could think of, because the damage is ongoing, and they are not over.

We do not oppose this bill, but we do oppose the situation this government has created. We support measures that strengthen our health system, but this bill is nothing but a bandaid on a gaping wound. Regional Victorians deserve better than being left on stretchers in ambulance bays for 5 hours. They deserve better than being forced to travel for maternity care, cardiac care and cancer treatment. They deserve better than being ignored by a government that refuses to listen to them. Labor has failed, and the consequences of that failure are being felt in our hospitals and our communities and in the devastating loss of life across the state. Enough is enough. It is time for a government that listens, it is time for government that acts and it is time for a government that puts regional Victorians first. This is not just policy or legislation, this is life or death now, and we will not stop fighting on this side of the house until every Victorian gets the health care they deserve.

To finish: to the health care workers that have to work in these conditions, I want to say thank you. So many of you I speak to often, but you are the real backbone of our healthcare system. Thank you for the comfort in the toughest of moments. You are the real heroes at the moment.

The ACTING SPEAKER (Wayne Farnham): Just before the member for Werribee starts, I will ask, as this is his first bill contribution, that he be heard in silence and given a fair go.

John LISTER (Werribee) (12:05): Thank you, Acting Speaker. I am pleased to rise to make a contribution on this bill, because as we know, Labor is the party of supporting healthcare workers. I could not think of a more important bill to make my first contribution on. Labor knows our health system is built on the skill, dedication and compassion of our nurses and midwives. At the 2022 election the government committed to further strengthening and protecting ratios. We committed to this because it is what our nurses and midwives told us they wanted.

With this bill we are delivering on that commitment. Our healthcare workers know that Labor has their backs. We are proudly the party of nurse-to-patient ratios, because enshrining ratios into law means they become the standard. We know our healthcare workers are some of the most skilled and professional in the world, and ratios are the best practice for safe patient care. It is why in 2015, under a Labor government, Victoria became the first state to enshrine these ratios into law, and now the Allan Labor government is building on this by introducing stronger and safer nurse- and midwife-to-patient ratios, ensuring the best care for Victorian patients and their families. The new ratios are the result of extensive consultation with nurses and midwives, their union the Australian Nursing and Midwifery Federation (ANMF) and health services and will set in stone one-to-one, one nurse to one occupied bed, ratios in intensive care units in level 1 and 2 hospitals; improved staffing ratios in resuscitation cubicles on morning shifts, bringing morning shifts in line with those afternoon and night shifts; one-to-four midwife-to-patient ratios in postnatal and antenatal wards on night shifts, down from one to six; and an in-charge nurse on night shifts in a standalone high-dependency unit.

To ensure health services are adequately supported and prepared to action these changes, these have been rolled out in a staged approach. Only the Allan Labor government will continue to support and invest in our dedicated workforce, because we know how important they are to delivering world-class care for all Victorians. The government committed $101.3 million in the 2023–24 budget to support the implementation of these new ratios. The new ratios build on the Labor government’s 28.4 per cent increase for our hardworking nurses and midwives, helping to retain and recruit more nurses so more Victorians can get the very best care.

[NAME AWAITING VERIFICATION]

During the campaign it was my honour to join nurses from Werribee hospital and the Premier to talk about their excellent work. Meeting these two proud ANMF union members, I learned about the benefits of having set standards for patient ratios. Before I started my contribution today I sent a text to one of those nurses, Melanie, and assured her that I have their back. I would like to pay tribute to these nurses and their colleagues at the Werribee hospital for all the work they do for our growing community. This legislation comes as demand at our hospital grows. These laws and the investment that goes with them are important to make sure that, as our community grows and demand grows, we maintain a safe ratio of these professionals to their patients.

Not only are we supporting the people that work within those walls, we are building a new emergency department to support this growth at the Werribee hospital. This project will see treatment spaces expanded from 33 to 67 and deliver four new resuscitation bays – which will have these ratios that we are putting into law today – 16 short-stay beds and 36 emergency care cubicles as well as a behavioural assessment room. It was a pleasure last week to join the Minister for Health Infrastructure and my neighbours the member for Tarneit and the member for Laverton to see the slab being poured at the project site and talk to the people there about how they had redesigned the emergency department to make it easier and more efficient to get people through. This project comes on top of our state-of-the-art critical care unit project. The $120 million project has expanded the hospital upwards, forever changing the skyline of the Princes Highway. We know that Labor is the only party that delivers this level of health investment in Werribee. When those opposite had the chance, they cut funding to our hospital. Not only do our nurses remember this, but also those patients who had to endure this lack of investment still remember how they neglected our western suburbs.

In my family you are either a teacher or a nurse. Last night two of my aunties came to see my inaugural speech. Ros worked for decades as a midwife at the Mildura Base Hospital and Annie has worked in emergency and other wards across south-west Victoria and back in Melbourne. I asked them about this bill and the ratios and what it means for them, and Ros replied, ‘Johnno, you need to make sure this is law, because I have experienced what it’s like to be run off my feet. We don’t want to go back to the bad old days.’

You see, we are doing this because there is always the risk that parties of a more conservative persuasion will take any opportunity to cut vital services in the western suburbs. I may be young, but I remember those opposite’s sneaky plan to cut hundreds of nurses and get the nurse-to-patient ratios out when they were last in government. When we first enshrined nurse-to-patient ratios into law all those opposite cared about – including the then leader the member for Bulleen – was the cost. I say to whichever number leader the Liberal Party is up to: the cost is deteriorating patient care. Only the Liberal and National parties cut, close and privatise health care in our western suburbs. With ratios being enshrined in law we need to make sure that staffing levels are boosted.

Relatively recently I was working with young people who were choosing what career to do. We would sit down and go through the surveys that they did and talk about what local opportunities there were in Werribee, and I was proud to see so many of those year 10s looking to become nurses in our hospitals. We worked hard to get them work experience in those healthcare settings, whether it was down at the Mercy or at Western general or down at the old folks homes nearby. Many of our young Karen students want to become nurses because they value service to the community that has helped raise them. They have seen their cousins or their aunties or their uncles go into nursing and have seen the benefit that has provided to not only their community but also the wider community in the western suburbs.

I look forward to working in my electorate to support these students in their endeavours, because this government continues to invest in the people delivering these critical life-saving health services, including with sign-on bonuses and supports to train and upskill, making it free to study nursing and midwifery, speech pathology grants and delivering our first paramedic practitioners. We have delivered training and recruitment programs, including the $270 million Making It Free to Study Nursing and Midwifery initiative to build the supply, capacity and quality of the nursing and midwifery workforce. The 2024–25 state budget invests a further $183 million in workforce initiatives, including an extra $28 million to support our health services, boost our workforce capacity and continue our successful registered undergraduate students of nursing or midwifery positions.

I have to say – because I am speaking quicker than I thought; first time, guys – that last week when I was out at the Mercy hospital and I got a chance to meet with the management there, they were telling me how significant it was to see all that investment that we have put in, not only to the buildings and concrete and bricks and mortar but also to the people there at the Mercy. We have been running training programs through there, linking in with local universities to make sure that we have got a pipeline of people to work in this hospital in our growing community. I was also really happy when I was having a chat to the CEO of Mercy there and got in his ear to ask if we could get some more work experience positions for these students out there, not only from my school but from all the other high schools in the area. I think it is really important to make sure that young people can see that not only are we giving them opportunities to do this training through that investment that I outlined but also we are making sure that they can see that we are taking it seriously and putting into law their rights at work.

There are a lot of western suburbs hospitals that are receiving these better ratios, like the Mercy and like Western general. But what I would say is that this legislation is important to me for all the reasons that I have highlighted – those reasons like making sure that we are the best in the world when it comes to our patient care and making sure that we make it very hard for people to wind these nurse-to-patient ratios back. Most importantly, it is important to me because it is for those students that I have seen heading into the workforce, whether it is through the initiatives that I have outlined or through things like free TAFE.

It is important because they need to have their ratios protected. It is my honour to keep working with our Australian Nursing and Midwifery Federation nurses out at Werribee Mercy and making sure that we are listening to them and acting in their best interests, and I will be out there as often as I can. I think they really enjoyed last time I was out there with the Premier. I think I am one of the first members of Parliament to ever take in boxes of chocolates and biscuits to the tearoom. As a fellow public service worker I know that one of the best things is making sure that we have got good things in the tearoom for our break.

Thank you to everyone for their patience. It is my honour to commend this bill to the house.

John PESUTTO (Hawthorn) (12:15): I rise to speak on the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Bill 2025. Who does not love our nurses? We all rely on them, we cherish them and they are an important part of our lives. When we are at our most vulnerable and when we are most susceptible to health challenges, fear and insecurity, it is nurses who, among our many health workers, walk us through some of the most challenging and at times some of the darkest moments in our lives, and we have all experienced it. I think we all have someone in our lives who is a nurse or who works in that noble profession. I certainly have a family where that is the case. We love what they do, and we cherish what they do. We rely on them heavily. That is why we are not opposing this bill. We certainly are going to allow this bill to proceed, but that is not my main concern about this bill.

I enjoyed the member for Werribee’s speech last night. I cannot say I agreed with his speech just now. I think what we need to recognise is that this Labor government is very good at making commitments but it is not very good at fulfilling those commitments. Often its commitments are wrong, but those that it makes it does not even bother to fulfil. The question we have got as an opposition and as an alternative government is: just how does the government propose to fulfil this commitment? The member for Werribee and a number of his colleagues have said, ‘There’s some money in the budget.’ There was some money in the 2023–24 budget, but it was not directly linked to ratios, so we do not know how much of that money will actually go to supporting health services. What none of those opposite have said in any of the contributions up to this point is: has this government assured every health service in Victoria of the amount of money it is going to get to support these nurse-to-patient and midwife-to-patient ratios? They have received nothing.

We have heard these health promises before. Let us remember that in the last financial year alone our health services, which support our nurses, our allied health workers and our doctors – everybody who works in this important sector – clocked up over $1 billion of operating deficits. What does that tell you – a billion dollars-plus of operating deficits in 2023–24? It tells you that this Labor government cannot plan for our health system. It cannot deliver for our health system. We had health services scrambling to deliver basic services that in a First World country we should be able to expect without hesitation. They are doing their best. We have the best health workers, we have the best nurses and we have the best midwives; we just have the worst government in this country overseeing our health system. Over a billion dollars in operating deficits – what a cataclysmic failure by a government to get it so wrong on health funding.

Not only that, we have had other instances when health services have had to operate with cash reserves that are negative. They did not have enough money to meet daily expenses and had to draw on funding in the form of temporary debt to fund the daily needs of most health services last financial year, and we are waiting to see the data for this year. They were operating with negative cash flow, and this government expects us all to believe that it is going to be able to fulfil the promises and the commitments made in this bill to fund ratios in this state. You have got to be kidding me.

We saw last year and in previous years under this government that because they cannot plan our health system they have used what we call Treasurer’s advances – those advances that a Treasurer makes when unforeseen and urgent priorities arise. Those have gone from $365 million a little over 10 years ago to a whopping $12 billion now, and a lot of it is to meet daily expenses in our health system. Last year, would you believe, the Treasurer was ready to write a Treasurer’s advance to fund wages. Can somebody please correct me: when did it become urgent and unforeseen to pay wages? Don’t you plan for that? This government cannot even get provisions for wages in our health system right. So badly off the mark was it that it had to use Treasurer’s advances, and it expects us to believe it will deliver on ratios. You have got to be kidding me.

For all those opposite, including our friend the new member for Werribee, remember that not more than 12 months ago this government was wielding a financial axe towards our health system and demanded a billion dollars in health cuts. Do you know what that did? Because this was over the change in financial year, this forced a number of our health services to cut staff. They had to cut services. They had to cut back on other priorities because the government was saying all 76 health services had to find cuts. At the end of the day they flipped and they said, ‘No, we’re not going to proceed with a billion dollars of cuts. We’ll give the sector $1.5 billion.’ It did not say where that money was going. It just wanted to put out a fire it had lit because of its own complete financial incompetence. Do not believe anybody on the other side when they say they can deliver on these ratios. Neither this Labor government nor any previous Labor government could demonstrate that they could actually deliver on these things.

What about the litany of broken promises? Acting Speaker Farnham, you mentioned one before. I know you have campaigned passionately for the West Gippsland Hospital – a broken promise. The Melton hospital is a broken promise. The 4000 ICU beds are a broken promise. The 240,000 annual elective surgeries are a broken promise – slashed, cut, iced to 200,000. Our waiting lists across a range of different categories of surgery continue to grow. Against that backdrop, can we actually trust the Allan Labor government to deliver on the ratios they are committing to in this bill? We do not oppose the ratios; that is not the issue here. The issue is that the government wants brownie points for legislating them. Victorians want more than that. Victorians want this government to actually commit to running the books of this state competently, prudently and responsibly so it can fund our nurses, not let them down. I say to every nurse in this state: the only thing that will bring this down is this Labor government, which cannot manage money, cannot manage the books. Victorians pay the price for that.

I just want to finish off on a broader exposé on themes of this government. We know that Victoria is growing, and I have spoken about this before. Even the government’s own Victoria in Future population figures from last year’s show that our state is growing quickly, faster than any other state or territory in the country. When you look at the outer growth corridors taken collectively, we are looking at growth between now and 2041 of about 1.8 million people. In the inner ring of suburbs and closer to the CBD we are looking at a figure closer to 380,000. We know that our population is growing rapidly, at a very high rate, in the growth corridors, and eventually that will go over into the regions.

The government announced recently its local health networks plan. My concern with this is that the government is pursuing it for the wrong reasons. We all know that you should reduce duplication and unnecessary red tape. You should always do that. That is just core business. But what the government is doing is reducing the coverage of our health networks around the state simply to cover financial black holes. If you look at its Plan for Victoria last week, the government finally cottoned on to what we have been saying. You cannot just jam all of the housing into a few municipalities. You have to have a broader statewide vision, which this government completely lacks. But they are trying to respond to our talking points on this and our narratives on this.

Now, if you go and read Plan for Victoria and then also compare that with the local health network plan, you will not find in there any correlation between the patterns of population growth in our state and provisions for health infrastructure and health services in the fastest growing areas of our state. There is a complete failure of leadership. This government makes a commitment on ratios, but when you look at the facts, when you look at the record and when you look at the broad sweep of failure of the most financially incompetent government in the country and in this state’s history, no-one can believe they will deliver for our nurses as they should.

Juliana ADDISON (Wendouree) (12:25): I rise to talk about the bill, to actually talk about nurses and to talk about patient care, quality care and looking after all Victorians from the womb to the tomb. That is what I am going to be talking about in my contribution today, because we love our nurses, we support our nurses and we respect our nurses. That is what is at the heart of this bill – respect for nurses. I am so pleased to be able to speak on the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Bill 2025, which will safeguard working conditions for nurses and midwives as well as safety for patients by improving minimum staffing ratios in Victorian hospitals.

I must acknowledge the member for Werribee on his first contribution to this place. Well done. It was a cracking contribution after an excellent inaugural speech last night. What an asset you are to our caucus. To the people of Werribee – you have chosen well, so thank you and well done.

The ACTING SPEAKER (Wayne Farnham): Through the Chair.

Juliana ADDISON: Thank you to the Minister for Health, her ministerial office and the Department of Health for their work in delivering this bill. In doing so, we are delivering on a commitment that this government has made to Victorians. The bill follows consultation with numerous stakeholders – and that is really important when we are talking about the health of all Victorians – particularly the Australian Nursing and Midwifery Federation, the ANMF, who are good friends of ours, and the Health Workers Union, the HWU, who do excellent work as well. I want to thank the state secretary Lisa Fitzpatrick AO and the leadership of the ANMF Victorian branch for their strong and unrelenting advocacy for their members; locally, our ANMF leadership in Ballarat, Cassia Drever-Smith and Stephanie Cooper; and all the ANMF members across Wendouree. Consultation on this bill also included our healthcare industry organisations the Victorian Healthcare Association and the Victorian Hospitals Industrial Association as well as Safer Care Victoria, the Department of Justice and Community Safety and of course the healthcare services right across our state.

I would like to recognise the many nurses in my community, particularly the nurses who work at our hospitals, our aged care facilities, the urgent care centre, medical clinics, the blood bank and our schools as well as our nursing students studying at Australian Catholic University (ACU) as well as Federation University. Thank you to Grampians Health chief nursing and midwifery officer Leanne Shea and the 1500 nurses who care for my community day in, day out. We have more than 200 presentations at Ballarat Base Hospital emergency department each day, and every patient is cared for by a nurse.

We also have our incredible midwives supporting expectant mothers and bringing our newest Victorians into the world. I had both my babies at Ballarat Base Hospital and am indebted to Tonya and all the midwives who cared for me and my two daughters. I would also like to shout out to the 65 new nursing graduates at Ballarat Base Hospital, and I hope that they are having a seamless transition from university to work practice. And we will never, ever forget – because they are far too important to forget – the incredible work of our nurses in residential aged care, who provide round-the-clock care for our oldest and most vulnerable community members.

I am proud that the Allan Labor government has funded a new education centre at the Ballarat Base Hospital, providing undergraduate placement training for ACU and Fed Uni students as well as providing a centre for ongoing postgraduate training for those nurses interested in advancing their careers. We know that our nurses have a lot to offer, so that ongoing professional development and the opportunity to grow and contribute more are so important.

It is in my community that the Allan Labor government is investing $655 million to redevelop the Ballarat Base Hospital, the largest investment in Ballarat’s history, and we will truly overhaul the facilities available to our community and to our hardworking and committed hospital staff. Once completed, the Ballarat Base Hospital will have capacity for thousands more surgeries annually and tens of thousands more inpatient and emergency services. I am committed to delivering world-class quality health care locally in my electorate of Wendouree across Ballarat and western Victoria, and our government is committed to delivering the same world-class health care for all Victorians.

Investing in training and retaining our healthcare workforce has increased almost 50 per cent under our government. That is an extra 40,000 healthcare workers supporting our community, and a quarter of those are in regional and rural Victoria. In just the most recent budget we invested an additional $183 million in healthcare workforce initiatives. We are committed to Victorian health care and respect our Victorian healthcare workers, and that is why the nurse-to-patient and midwife-to-patient ratios have been enshrined in law here with the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Act 2015, a first for an Australian state. It is also why we delivered another tranche of improvements in 2019 and 2020 and have since committed to further strengthening ratios in Victorian emergency departments as well as intensive care, coronary care and high-dependency units. With this bill we are delivering on the promises now.

Enshrining stronger, safer specific patient ratios within law protects patients, but it also protects our healthcare workforce. Victorian nurses and midwives are skilled, hardworking and vital, and this has been brought to everyone’s attention through their incredible work in the wake of the COVID pandemic. These workers prioritise patient safety, and we must make sure to prioritise them. They hold a range of advanced skills and safeguard a wealth of institutional knowledge which our healthcare system cannot afford to overlook. For these reasons and many, many more we are listening to our nurses and midwives when they call for further improvements to patient ratios.

This bill we are considering today will legislate support for closer nursing care within a range of specialised hospital areas. I want to talk about the ICU and I want to talk about the high-dependency units and coronary care units, but I am worried that I have just got so much to talk about on this bill that I am not going to get through it. But I really want to talk about the intensive care units, because, as the name suggests, it is intensive care for our sickest and most vulnerable patients in the system. Intensive care units are where critically ill patients, including the most acutely unwell and seriously injured, can be closely and thoroughly cared for. This bill reflects this in the definition it inserts within the act before it goes on to legislate for nursing ratios and additional nurse requirements that are specific to ICU.

First and foremost, these amendments introduce a requirement for one nurse per every ICU bed at each of the 23 level 1 or 2 hospitals across our state. Having spent more time than I would like in the Monash ICU with my daughter Johanna after a significant and frightening health episode, I know firsthand how important this level of care is. That is one dedicated ICU nurse for each critically ill patient and one dedicated ICU nurse for each patient on sustained organ support, and this bill will provide additional nursing care within intensive care units with a dedicated nurse in charge for every shift plus at least one team leader to deliver coordinated on-the-ground support for bedside staff. Liaison nurses will also be available during mornings and afternoons in level 2 hospital ICUs and around the clock in level 1, further ensuring that the needs of critically ill patients will be identified and then met.

In addition to the ICU-specific amendments, this bill seeks to reinforce the nursing requirements within other specialised hospital units. Standalone high-dependency units can facilitate close monitoring outside of the ICU for patients with appropriate levels of need, while coronary care units provide specialist care for serious cardiac arrest cases. HDUs and CCUs are already required to have a nurse in charge rostered for every morning and afternoon shift, and with this bill this requirement will be extended to p.m. shifts as well.

Increasing staffing and supervision during nights in these critical units will only benefit these patients and their staff, and I fundamentally believe it will give a level of comfort to family and loved ones worried about their loved one in our hospitals. The bill’s initial focus on critical patients also extends to emergency departments, which is so important, with improvements to existing staff ratios in resuscitation cubicles. The act already requires one nurse per resuscitation bed during afternoons and nights. However, in the broader ED the one-to-three ratios will apply during the morning shifts.

In closing I want to say that I am very pleased that we are going to be implementing this – 25 per cent initially then 75 per cent by 1 December and 100 per cent by 1 July 2026 for our nurses, for our patients, for all Victorians. I commend the bill to the house.

Tim READ (Brunswick) (12:36): Before I begin, I just signal to whoever is speaking next that I am making very brief comments on this bill, and I will not be using all of my time. With regard to the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Bill 2025 my comments on behalf of the Greens are that we welcome the bill before us, which proposes a number of improvements to patient ratios in hospital settings to strengthen the quality of patient care and support the wellbeing of our hardworking nurses and midwives. As we have already heard during today’s debate, the bill proposes a phased approach to new minimum workload arrangements, specifically in intensive care, high dependency, primary care and emergency settings. The bill also introduces improved staffing ratios in postnatal and antenatal wards, and the Greens understand that these changes are supported by the Australian Nursing and Midwifery Federation along with many practitioners in the field, and so we will be supporting the bill before us today.

Victoria’s nurses and midwives are critical to our health system, and we are proud to stand alongside them as they seek improved conditions – conditions which are inherently linked to better patient outcomes, a goal that I know they prioritise. Patients will also welcome these changes. How often have we heard a patient complain that they press the buzzer and no-one comes and complain of spending seemingly hours isolated in a bed alone with no-one coming to their aid. While these stories are common enough, it is largely due to the fact that there was someone else on the ward who was much sicker than they were who was demanding the staff time. Adequate nurse–patient ratios will mean this is less likely and that patients will get more attention.

Sadly, the bill before us today does not extend to mental health services, which also happens to be an overdue election promise of this Labor government. In 2018 the then Andrews government committed to legislating the 2016 mental health nurses enterprise agreement’s staffing profiles in bed-based services, and seven years on many are still waiting for this change. This year mental health nurses are again engaging with the Victorian Hospitals Industrial Association to negotiate a new enterprise bargaining agreement. A key request has been the implementation of increased nurse–patient ratios, so why not take the opportunity of the bill being considered in Parliament today to action this long-overdue promise? Many are scratching their heads.

The lack of legislated ratios or staffing profiles when many other nurses are provided with this protection inevitably leaves the mental health workforce feeling like they are not an equal and important specialty within the nursing profession, when we all know their role in our health system is essential. Evidence suggests that adequate nurse-to-patient ratios in mental health settings can reduce patient aggression and the need for restraint or seclusion. If we are serious about doing that, then we need sufficient staff on wards. Numbers, of course, are not the only thing we need. Experience is important too, and I have heard reports of very junior staff supervising difficult mental health wards.

It is important to remember that whilst we can legislate for improved ratios in public hospitals, the effective implementation of any legislative change requires proper resourcing, including the presence of the actual workforce numbers to fill these positions. I implore the government to not legislate these changes and then wipe their hands of this much-needed work. They must also commit to the proper support of our workforce and initiatives for new workforce to enter the field and, importantly, for the retention of existing staff.

Of course staff do not come cheap, and hospital care is the most expensive part of our healthcare system. For that reason it is important that the government redouble their efforts to adequately fund preventive health care. Primary prevention is far more cost-effective than funding hospital care once prevention has failed. So on that note the Greens look forward to a similar bill to this one, which will ensure sufficient staff on mental health wards. We look forward to an improvement in funding for preventive health care, and of course we support this bill.

Kat THEOPHANOUS (Northcote) (12:40): I am delighted to rise to speak in support of this wonderful, wonderful bill about nurse-to-patient and midwife-to-patient ratios. Nurses and midwives truly are the best of us. The knowledge and skill they bring to Victoria’s healthcare system is a core part of what makes it world class – and make no mistake, it is world class. The contribution of this critical workforce extends well beyond the clinical. Our nurses and midwives embody that special relationship of trust that exists between patients and our health system. In moments of vulnerability Victorians rely on the care, dedication and expertise of these highly qualified professionals. It is a bond that demands our deep respect and understanding just as much as it demands our continued support to empower nurses and midwives to deliver the level of care they know their patients need. That is why, as a Labor government, we will always listen deeply to our nurses and midwives and why in 2022 we committed to further protecting and strengthening the nurse-to-patient ratios that we had embedded in our last term. We committed to this because nurses and midwives told us it is critical to improving patient outcomes and the wellbeing of the workforce. We know how much additional pressure has been put on our health system and health workers and the unprecedented demand that has flowed on from the acute phase of the pandemic. We also know that the research tells us that better ratios mean lower mortality rates, shorter stays, less readmissions and better outcomes for both patients and workers.

The logic and the benefits are crystal clear, which is why this bill sets in stone one-to-one ICU nurse ratios, meaning every occupied ICU bed in level 1 and 2 hospitals will have a dedicated nurse on shift, so there is always one-to-one care. Plus for the first time ICUs will require a team leader and a liaison nurse. The bill improves emergency department resuscitation staffing, so morning shifts in ED resuscitation cubicles will now have the same staffing levels as afternoon and night shifts, improving care around the clock. It reduces midwife-to-patient ratios on night shifts. Midwives in postnatal and antenatal wards will care for a maximum of four patients each, down from six, giving new patients and babies more support. Standalone high-dependency units and coronary care units will now have an in-charge nurse on night shifts, ensuring strong leadership and oversight. These changes will help deliver safer, more consistent care across our hospitals and back our health workers to do what they do best – care for Victorians.

Almost 6 per cent of working residents in my electorate of Northcote are employed in hospitals. It is the single largest proportion of workers in any one industry in my patch. So these changes have deep, real-life impact for countless people in my community – not just for those individuals but for their families, their patients and the flow-on wellbeing to our community.

Nurse-to-patient ratios were of course introduced back in 2000, but they were almost lost when the former Liberal government tried to force our nurses and midwives to trade them away in enterprise agreement negotiations. That taught us a valuable lesson. These ratios must be protected, and Labor is the party that will protect them. It is why in 2015 we made Victoria the first state to enshrine the ratios into law and why we are here again making them stronger.

Importantly, this is not a standalone measure. Our work to support our health workforce and our health system goes well beyond ratios. Since coming into government Labor has expanded Victoria’s healthcare workforce by nearly 50 per cent. That is an additional 40,000 more nurses, midwives, doctors and allied health professionals on the ground delivering the care Victorians rely on. We have delivered a historic 28.4 per cent pay increase, helping to retain and recruit more nurses and midwives. The new agreement also embodies better opportunities for career progression, improved night shift penalties, more access to flexible work arrangements and the right-to-disconnect clause.

There is a reason health workers travel from across the world to be in our hospitals and our health services. They know we have backed our health workers every step of the way with better pay, better conditions and the resources they need to do their jobs to a world-class standard. In this year’s budget alone we have invested an additional $1.5 billion on top of the $8.8 billion already committed, bringing total health funding to more than $20 billion, making up over a quarter of Victoria’s entire budget. We are not just funding services; we are building the future of health care, with $15 million in health infrastructure projects. One of these critical projects is upgrading the emergency department at the Austin Hospital. This upgrade is so important to my community. As our suburbs continue to grow, it will enable the ED to treat an additional 30,000 patients each year.

In Northcote we also have a commitment to an early parenting centre, another fantastic service and initiative spearheaded by our Labor government. These centres are there to support families in those crucial early stages, providing wraparound and multidisciplinary support for both parents and children. The care team includes nurses, midwives, social workers and parenting practitioners. They are there for families when things get too overwhelming, and that so often happens when you have little babies. Families get support with sleep and settling, bonding and mental health in the safety and comfort of individual overnight rooms or through day-stay programs. It is an extraordinary public health service, one that speaks to the village of support that is needed in raising a child. None of these incredibly important services would be possible without the workforce that supports them, our healthcare workers, working within a strong, well-funded public health system.

Victoria is ultracompetitive when it comes to attracting a skilled health workforce. Under our Labor government we have supported countless initiatives like sign-on bonuses, making it free to study nursing and midwifery, delivering Australia’s first paramedic practitioners and dedicated funding for women’s health practitioners. As Parliamentary Secretary for Women’s Health, I know we have also done some things that probably get a little less media attention but which are critically important – things like removing barriers that had prevented midwives from working to their full scope of practice, something that has now unlocked a whole world of accessible care, particularly for rural and regional communities.

Indeed, the rollout of our historic women’s health reforms has hugely benefited from the involvement of the Australian Nursing and Midwifery Federation, and in particular I would like to give a shout-out to assistant secretary Madeleine Harradence, who is on our Victorian Women’s Health Advisory Council. Maddie does a superb job of flying the flag for nurses in the context of women’s health, and we are working closely on the rollout of additional sexual and reproductive health hubs, our first dedicated women’s health clinic, a mobile and virtual clinic and an Aboriginal women’s health clinic. This year we will also be launching the findings of our inquiry into women’s pain as part of our holistic approach to improving care for Victorian women and girls.

Listening to and supporting our nurses and midwives is essential, not just to keep them engaged and employed in our health services but to inspire them to grow in their careers and mentor the next generation. It is about valuing their dedication and ensuring they remain on the front line, delivering the exceptional care our community relies on. It is an investment that pays off every single day, strengthening our health system and caring for those who need it most. I do want to mention that investing in this predominantly female workforce has another important element, and that is driving real change towards gender equality.

We have moved well beyond the outdated idea that those that dedicate their lives to caring for others should do it purely out of goodwill without fair pay. Not only do our nurses and midwives deserve our respect, they deserve the pay and conditions that match the vital role they play in our society. By valuing and fairly compensating those in this historically undervalued industry, we are taking meaningful steps to close the gender pay gap.

Before I finish I want to take a moment to thank the thousands of dedicated health workers in Northcote and more broadly in Victoria. As the member for Northcote and in my role as parliamentary secretary I have heard so many anecdotes from people who are deeply grateful for the care they have received in our health system. Despite the anguish that comes with any health crisis, what resonates, what people so often remember, is the nurse who sat by their side in the middle of the night, the paramedic who arrived in a moment of crisis and the doctor and midwife who guided them through the rollercoaster of childbirth. Health workers do not just treat illness and injury, they provide comfort and reassurance and strength when people need it most. They are there on our darkest days through uncertainty, pain and fear as well as in moments of joy, relief and the magic of life itself. It is not easy work. I do not want to romanticise it. There are long shifts and there is vicarious trauma; there is a toll that these roles take. That is why it is so important that we value this workforce, that we invest in them and that we give them the conditions that they deserve.

David SOUTHWICK (Caulfield) (12:50): I rise to make some comments on the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Bill 2025. I will say from the outset that there have been a number of contributions today that have highlighted the great work that our nurses and midwives do in the healthcare sector, and I particularly want to put on record my thanks to the many nurses that go above and beyond and the great work that they do on the front line. They are frontline workers. They are those that meet patients right from the very beginning and take them through a journey that is not the easiest for the patient or for their families, and every single one of us would have a story to tell of an experience of a loved one that has had to go through that process.

We have recently had to experience that with my father-in-law, who just over a week ago had a stroke and unfortunately has lost movement in the left side of his body. It has been very harrowing for the family and a very difficult time. It is interesting watching that process and following that process and as family members always searching for ‘What’s the next stage? What’s the next option?’ We know that all healthcare workers do an amazing job and our doctors are truly amazing as well. But some doctors do not necessarily have the best bedside manner in terms of talking to patients and talking to family members at these difficult times. That was an experience that we certainly had, and it left the family, my wife and others quite traumatised. I know many people listening to this debate today would think of a similar situation. It was the nurses that were left to pick up the pieces and to provide that reassurance, provide the pathway and provide the options for the family in terms of what would come next.

I think of the work that healthcare workers do in our hospitals right across the board, and it is not necessarily a glamorous job that many of them have to do. For some of them it certainly is in terms of the care and the love and the work that they give and the admiration, but it involves all kinds of elements of the work at all ages in our hospitals. We must ensure that they are paid appropriately but also that we have enough resources in our hospitals. Certainly the opposition has made that note today that we need to get the nurse–patient ratios right; we need to ensure that we also provide the resourcing and the funding necessary to do that. We know nurses are stretched, and that is something I have seen time and time again in our hospitals. Nurses are stretched. Ambulances are stretched. We still see ramping in our hospitals every single day, we still see it is very hard to get a bed in a hospital and we still see the constant movement of those people in terms of just trying to get health care. That is something that over the last decade we have seen deteriorate, unfortunately, here in Victoria. That is not the fault of our nurses, who do a fantastic job. It is not the fault of our healthcare workers. Unfortunately, it is the fault of the government not being able to provide the resourcing necessary.

We heard only late last year the former Treasurer having to give a cash advance to effectively pay the wages of our healthcare workers because the government was short on funds. That shows you just how desperate things have become in terms of government waste and mismanaging money. That is why it is important to bring this legislation into place – very, very important. But at the same time we need to understand how it is going to be funded, and it is very fair of an opposition to ask those questions of the government in terms of how it is going to be funded and how it is going to be implemented. We do not want to see nurses currently jeopardised and stretched as a result of that, because we are going to need more nurses. We are going to need more coming into the system, but at the same time we have got to ensure we can fund that. It is wonderful to stand up and say the government is going to do one thing, but they need the details of how that is going to be funded. Those are some of the questions that we have been asking in terms of this particular bill. It is about being able to ensure that there is proper resourcing and proper funding that is available right across the board.

I want to just refer to some of my hospital and healthcare workers, particularly at Caulfield Alfred Health. They do a wonderful job. If you walk about the facility at Caulfield Hospital, it is still so old and still so tired. We want to support our healthcare workers and we want to pay them, but we also want to provide an environment for them and also the patients that is conducive to working, and quite frankly, it is not. It still has some of the old infrastructure that was there pre 1918 in war days. Some of that still has not been upgraded. Certainly at the last election we were talking about a rebuild of the hospital. I know funds are really tight, but there has got to be investment in our health care, in our hospitals and in our infrastructure to get that right. We have got to provide the nurses and the care, and we have got to provide the infrastructure as part of all of that.

If you look at the Prahran campus of Alfred, which is across the road from my electorate, you only have to go to some of those wards to see for yourself just how poor a state that they are in. I mentioned my father-in-law earlier when I started this contribution. My father-in-law was down in the stroke ward. It is terrible. It has great care – do not get me wrong – and great nurses, but it is a terrible old ward. It really is; it is pretty substandard. I see the difficulty in terms of that. Again, here is a hospital that is so revered – the Alfred – in terms of what it does, but it has not had the funding. I know that CEOs, including the previous CEO and the current CEO, have gone in time and time again and asked for funding for a massive rebuild in the Alfred Hospital but have not received that funding. It is very, very important to have the funding that is necessary to ensure that patients are not treated in such a manner – more beds, because that is really, really important. There is a great opportunity to build more beds at the likes of the Alfred, which just needs to have the money – and the government needs to be able to provide the money – to provide the beds and to provide the upgrades.

This is all about good health care. This is all about good outcomes. It is all about, largely, an expectation that most Victorians would have, and we do not have that in Victoria. I remind people of what happened – I remember this; it was when I was first elected – back in 2010. The then Deputy Premier was from the National Party. I took the former Deputy Premier on a trade mission to Israel, and we looked at nurse–patient ratios in Israel. We looked at an industry that was booming over there called health tourism. What was happening with the hospitals there was that people who were coming there and getting specialised care – from Europe, Russia and other places – helped fund the hospitals. We thought that would be a really good opportunity for Victoria, and Victoria was actually doing it. Even back then, between 2010 and 2014, there were people coming in –

Members interjecting.

David SOUTHWICK: The member for Ballarat – sorry, Wendouree – was shaking her head.

The ACTING SPEAKER (Wayne Farnham): Through the Chair.

David SOUTHWICK: Well, let me remind the member for Wendouree that this is what was happening. It was happening back when Crown –

Juliana Addison interjected.

The ACTING SPEAKER (Wayne Farnham): Through the Chair. Member for Wendouree, you have had your turn.

David SOUTHWICK: The member for Wendouree clearly has no idea about the history of work that was done in our healthcare system over the time. We had people at the likes of Crown Casino, and people were funding hip operations and speciality care. That was funding general care in our hospitals. It was done as part of a health tourism opportunity. The hospitals, including some of our big hospitals, were looking at being able to do that here. We cannot do that now, member for Wendouree ‍–

The ACTING SPEAKER (Wayne Farnham): Through the Chair, member for Caulfield.

David SOUTHWICK: because we have a massive shortage of investment. The member for Wendouree would know that this government has not funded our health care in the way that it should and therefore patients are suffering.

Juliana Addison interjected.

The ACTING SPEAKER (Wayne Farnham): Order! Member for Wendouree!

David SOUTHWICK: The member for Wendouree can interject all she likes, but the member knows clearly that patients are being left in the dark simply because this government has failed to act. We see so many people who, when then call an ambulance, unfortunately cannot get one, or when they do get one, they are ramped outside a hospital because they cannot get a bed and they cannot get that service. This government can pat themselves on the back all they like, but this government have failed when it comes to health. We have a health crisis, we have had a health crisis, and it is very, very simple: if you do not fund health care, you get bad results. We have fantastic nurses and fantastic healthcare workers, but this government has failed to provide the money to ensure that patients can get the kind of quality care that they deserve. You know it. You can have your head in the dark. This government and the member for Wendouree can have their heads in the dark. But I will tell you what, she only needs to talk to some of her constituents in Wendouree to know that the Allan Labor government has failed them in delivering quality healthcare outcomes for Victoria and for Victorians.

Sitting suspended 1:00 pm until 2:01 pm.

Business interrupted under standing orders.